Healthcare Provider Details

I. General information

NPI: 1295162576
Provider Name (Legal Business Name): KELLY LYNN BALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLY LYNN NAGLE

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43114 CORTE ALMONTE
TEMECULA CA
92592-3632
US

IV. Provider business mailing address

43114 CORTE ALMONTE
TEMECULA CA
92592-3632
US

V. Phone/Fax

Practice location:
  • Phone: 708-466-4221
  • Fax:
Mailing address:
  • Phone: 708-466-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: