Individual
MISTI BALLEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3520 CHANDLER RD, MUSKOGEE, OK 74403-4910
(918) 478-6005
(918) 682-8321
Mailing address
PO BOX 751, HULBERT, OK 74441-0751
(918) 772-3390
(918) 772-2244
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
91434
OK
Other
Enumeration date
03/07/2015
Last updated
10/22/2015
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