Provider Demographics
NPI:1366067373
Name:BALMER, LUKE
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:BALMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 STONY POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1900
Mailing Address - Country:US
Mailing Address - Phone:804-828-2161
Mailing Address - Fax:804-998-1255
Practice Address - Street 1:9000 STONY POINT PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1900
Practice Address - Country:US
Practice Address - Phone:804-828-2161
Practice Address - Fax:804-998-1255
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAAG06200129363LG0600X
VA0024179499363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology