Healthcare Provider Details

I. General information

NPI: 1972223915
Provider Name (Legal Business Name): BETHANY P BALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 FOUNTAINS BLVD STE 1
MADISON MS
39110-6317
US

IV. Provider business mailing address

1 MILLER PKWY APT 7206
JACKSON MS
39211-1854
US

V. Phone/Fax

Practice location:
  • Phone: 601-499-1105
  • Fax:
Mailing address:
  • Phone: 662-803-0196
  • Fax: 615-523-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number905499
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: