Provider Demographics
NPI:1194053827
Name:BALL, CASEY RHAE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:RHAE
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:RHAE
Other - Last Name:MCALLISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:910 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65409-6519
Mailing Address - Country:US
Mailing Address - Phone:573-341-4284
Mailing Address - Fax:573-341-6967
Practice Address - Street 1:910 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65409-3512
Practice Address - Country:US
Practice Address - Phone:573-341-4284
Practice Address - Fax:573-341-6967
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001019164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO117400016Medicare PIN
MO261848Medicare Oscar/Certification