Healthcare Provider Details

I. General information

NPI: 1407969017
Provider Name (Legal Business Name): DEBORAH LYNN BALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583C E RIVERSIDE DR
NORTH TAZEWELL VA
24630-9573
US

IV. Provider business mailing address

RR 4 BOX 5000
CEDAR BLUFF VA
24609-9720
US

V. Phone/Fax

Practice location:
  • Phone: 276-979-9899
  • Fax: 276-935-2889
Mailing address:
  • Phone: 276-964-7481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: