ELIZABETH SVYATOSLAVNA BALYAKINA


Address: 855 Montgomery St, Fort Worth, TX 76107-2553
Phone: (817) 735-2498

ELIZABETH SVYATOSLAVNA BALYAKINA (NPI# 1275073215) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1275073215
Entity Type Individual
Full Name ELIZABETH SVYATOSLAVNA BALYAKINA
Credential MS, MPH, DO
Practice Address 855 Montgomery St
Fort Worth
TX 76107-2553
Practice Telephone (817) 735-2498
Practice Fax Number 8177350216
Mailing Telephone (817) 735-2498
Mailing Fax Number 8177350216
Enumeration Date 2017-02-23
Last Update Date 2017-07-04
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 390200000X Student in an Organized Health Care Education/Training Program Student, Health Care

Office Location

Street Address 855 MONTGOMERY ST
City FORT WORTH
State TX
Zip Code 76107-2553

Providers in the same location

NPI Name Taxonomy Address Enumeration
1831194455 Patricia Lowrimore Psychiatry & Neurology 855 Montgomery St, Fort Worth, TX 76107-2553 2005-06-20
1194353417 Jason L Thompson Student in an Organized Health Care Education/Training Program 855 Montgomery St, Fort Worth, TX 76107-2553 2020-03-31
1639701808 Tyrane Roberts-lagrone Pharmacist 855 Montgomery St, Fort Worth, TX 76107-2553 2020-02-06
1144860917 Melissa Edwards Petersen Clinical Neuropsychologist 855 Montgomery St, Fort Worth, TX 76107-2553 2020-01-09
1629553813 Lisa Jane Killam-worrall Pharmacist 855 Montgomery St, Fort Worth, TX 76107-2553 2018-10-03
1598250607 Sima Taj Mozdbar Optometrist 855 Montgomery St, Fort Worth, TX 76107-2553 2018-06-30
1588153993 Kristen Reuter Social Worker 855 Montgomery St, Fort Worth, TX 76107-2553 2018-05-02
1114431624 Emily J. Clark Counselor 855 Montgomery St, Fort Worth, TX 76107-2553 2017-11-20
1588103659 Frederick Olen Barnum Iv Family Medicine 855 Montgomery St, Fort Worth, TX 76107-2553 2017-02-21
1760926695 Jane Elizabeth Classen Nurse Practitioner 855 Montgomery St, Fort Worth, TX 76107-2553 2016-12-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1629683602 Renovo Wound and Hyperbarics Pllc Emergency Medicine 5668 Edwards Ranch Road, Suite 101, Fort Worth, TX 76107 2020-09-15
1669085437 Ryan Bourgeois Nurse Practitioner 2917 Crocket Street, Fort Worth, TX 76107 2020-08-31
1053920546 Christa Marie Widjaja Optometrist 1700 Montgomery St, Fort Worth, TX 76107 2020-07-30
1093351355 Raymond Iannone Pharmacist 850 Montgomery St, Suite #310, Fort Worth, TX 76107 2019-11-21
1053963744 Cumulus Injury Resolution, Inc. Chiropractor 4936 Byers Avenue, Fort Worth, TX 76107 2019-07-12
1770135576 Shadia Osakwe Physician Assistant 855 Montgomery Street, Pediatric Clinic, Fort Worth, TX 76107 2019-07-11
1568945442 Sachin P Patel Physical Therapist 4825 Wellesley St, Fort Worth, TX 76107 2018-09-07
1023594025 Ftw Pharmacy Services Inc Durable Medical Equipment & Medical Supplies 2912 W 6th St Ste 150, Fort Worth, TX 76107 2018-07-13
1669974325 Helen Williamson Elliott Counselor 1751 River Run #217, Fort Worth, TX 76107 2018-03-08
1487156931 Pelvic Neuromonitoring Pllc Electrodiagnostic Medicine 111 Boland St #211, Ft Worth, TX 76107 2018-03-01
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Taxonomy Information

Taxonomy Code 390200000X
Grouping Student, Health Care
Classification Student in an Organized Health Care Education/Training Program

Taxonomy Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
Notes: [1/1/2005: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1922607373 Benjamin Allen Barrett Student in an Organized Health Care Education/Training Program 12244 Langley Hill Dr, Fort Worth, TX 76244-5544 2020-10-17
1538766597 Billy Derek Huddleston Student in an Organized Health Care Education/Training Program 4661 Cool Ridge Ct, Fort Worth, TX 76133-3831 2020-10-02
1942828371 Ellener Harper Student in an Organized Health Care Education/Training Program 9232 Oldwest Trl, Fort Worth, TX 76131-3114 2020-07-13
1396374005 Mikel Robert Bell Student in an Organized Health Care Education/Training Program 855 Montgomery St Ste 257, Fort Worth, TX 76107-2553 2020-04-04
1750919171 William Thomas Cates Student in an Organized Health Care Education/Training Program 3248 W 7th St Apt 308, Fort Worth, TX 76107-2804 2020-03-31
1710514690 Javier Eduardo Ordonez Student in an Organized Health Care Education/Training Program 3512 Princess Victoria Ct, Fort Worth, TX 76137-6074 2020-03-23
1548896749 Eric Bash Student in an Organized Health Care Education/Training Program 6137 Obsidian Creek Dr, Fort Worth, TX 76179-1543 2020-03-19
1700417821 Abigail U Davis Student in an Organized Health Care Education/Training Program 5113 Glen Canyon Rd, Fort Worth, TX 76137-4104 2020-01-28
1699312439 Lacey Jane Arnett Student in an Organized Health Care Education/Training Program 3305 West Cantey St, Fort Worth, TX 76129-0001 2019-11-27
1699322396 Anastasia Davis Student in an Organized Health Care Education/Training Program 3628 Woodmoor Rd, Fort Worth, TX 76133-6336 2019-08-19
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Competitor

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City FORT WORTH
Zip Code 76107

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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