MEDICARE: ASHLEY BALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	25138	TN
2	363L00000X	Nurse Practitioner	0024176798	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25138	OTHER	TN	AANP
2	0024176798	OTHER	VA	AANP

General Provider Information

NPI Number	:	1356811863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY BALL

Provider Business Mailing Address
First Line	:	590 W RIDGE RD STE M
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-1067
Country	:	US
Telephone Number	:	276-625-8870
Fax Number	:	276-228-2010

Provider Business Practice Location Address
First Line	:	590 W RIDGE RD STE M
Second Line	:
City	:	WYTHEVILLE
State	:	VA
Zip	:	24382-1067
Country	:	US
Telephone Number	:	276-625-8870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	03/26/2020

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Directions to “ ASHLEY BALL ” Practice Location

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