Healthcare Provider Details

I. General information

NPI: 1497802672
Provider Name (Legal Business Name): LISA SHERRY DEBBY BALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 YOUNGS RD
WILLIAMSVILLE NY
14221-8054
US

IV. Provider business mailing address

1140 YOUNGS RD
WILLIAMSVILLE NY
14221-8054
US

V. Phone/Fax

Practice location:
  • Phone: 716-688-0020
  • Fax: 716-688-0020
Mailing address:
  • Phone: 716-982-4165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF334452
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number520995
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: