Individual
KAREN L BALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3464 E CATALPA ST, SPRINGFIELD, MO 65809-1402
(417) 827-0880
Mailing address
3464 E CATALPA ST, SPRINGFIELD, MO 65809-1402
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
083688
MO
363LF0000X
Family Nurse Practitioner
Primary
083688
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083688
STATE LICENSE
MO
05
—
1891896098
—
MO
05
—
427720750
—
MO
Enumeration date
09/26/2006
Last updated
01/22/2021
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