Healthcare Provider Details

I. General information

NPI: 1215843909
Provider Name (Legal Business Name): GARY BRANDON BALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SW GAGE BLVD
TOPEKA KS
66622-0001
US

IV. Provider business mailing address

801 DAKOTA AVE
HOLTON KS
66436-1261
US

V. Phone/Fax

Practice location:
  • Phone: 785-350-3111
  • Fax:
Mailing address:
  • Phone: 785-350-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number46090
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: