Active NPI
Lisa Ballantyne
- Psychiatric/Mental Health Registered Nurse
- Santa Rosa, CA
National Provider Identifier
1730646746
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Registered Nurse
- License
- 612777
- Practice address
- 2245 Challenger Way
Santa Rosa, CA 95407-5418 - Phone
- (707) 565-4970
- NPI assigned
- Feb 26, 2019
- Last updated
- Feb 26, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 612777 | CA | Primary |
Addresses
Primary practice location
2245 Challenger Way
Santa Rosa, CA 95407-5418
Mailing address
2245 Challenger Way
Santa Rosa, CA 95407-5418
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 612777 | Other | CA | MEDI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 612777 | CA | MD | Psychiatric/Mental Health Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1551139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551139200000",
"number": "1730646746",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2245 CHALLENGER WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2245 CHALLENGER WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075418",
"telephone_number": "707-565-4970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BALLANTYNE",
"first_name": "LISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-26",
"last_updated": "2019-02-26",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0808X",
"taxonomy_group": "",
"desc": "Registered Nurse, Psychiatric/Mental Health",
"state": "CA",
"license": "612777",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "612777",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.