Provider Demographics
NPI:1194508101
Name:BALL, JENNAVERE RENAE
Entity type:Individual
Prefix:
First Name:JENNAVERE
Middle Name:RENAE
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 EDGEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8352
Mailing Address - Country:US
Mailing Address - Phone:208-315-3458
Mailing Address - Fax:
Practice Address - Street 1:7308 EDGEBROOK DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8352
Practice Address - Country:US
Practice Address - Phone:208-315-3458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant