Individual
GAGANDEEP BAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11 PROFESSIONAL PKWY, RIDGELAND, MS 39157-4114
(601) 856-2460
(601) 856-4687
Mailing address
11 PROFESSIONAL PKWY, RIDGELAND, MS 39157-4114
(601) 856-2460
(601) 856-4687
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
901853
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0716953
MEDICAL LICENSE
MS
Enumeration date
09/26/2017
Last updated
11/07/2017
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