Provider Demographics
NPI:1164680732
Name:BALCH, DANA FAYE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:FAYE
Last Name:BALCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 WORLDS FAIR PARK DR UNIT 504
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2061
Mailing Address - Country:US
Mailing Address - Phone:901-267-2344
Mailing Address - Fax:
Practice Address - Street 1:3685 S HOUSTON LEVEE RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9014
Practice Address - Country:US
Practice Address - Phone:901-457-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013231363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily