Healthcare Provider Details

I. General information

NPI: 1376505123
Provider Name (Legal Business Name): CARLA C. BALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 N 900 E
AMERICAN FORK UT
84003-9183
US

IV. Provider business mailing address

6021 WENDING LN
WEST VALLEY CITY UT
84128-2544
US

V. Phone/Fax

Practice location:
  • Phone: 801-763-4000
  • Fax:
Mailing address:
  • Phone: 801-963-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number145545-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: