Individual ProviderStephanie BallyNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address926 Main St, Nashville, TN 37206-3614(615) 436-9060PECOS EnrollmentBased on the most recent information from CMS, provider Stephanie Bally is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 6 days ago.Profile DetailsProvider ID1356991772Provider TypeIndividualFull NameBally, StephanieCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date9/17/2019Last Updated3/21/2024Contact InformationPractice LocationPractice Address926 Main St, Nashville, TN 37206-3614Phone(615) 436-9060Fax(615) 235-9725Mailing LocationMailing Address2002 N Quail Crossing St, Andover, KS 67002-7525PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense78990KansasCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense5378990072KansasProvider IdentifiersIDDescriptionIssuerID201267470ADescriptionMedicaidIssuerUnlistedKansas