Healthcare Provider Details

I. General information

NPI: 1912050758
Provider Name (Legal Business Name): AMY C BALL P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E MANSION ST STE 3A
MARSHALL MI
49068-1559
US

IV. Provider business mailing address

215 E MANSION ST STE 3A
MARSHALL MI
49068-1559
US

V. Phone/Fax

Practice location:
  • Phone: 269-789-0025
  • Fax:
Mailing address:
  • Phone: 269-789-0025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5601004406
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: