Provider Demographics
NPI:1215126107
Name:BALL, GLENDA BEEKMANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:BEEKMANN
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:GLENDA
Other - Middle Name:SARAH
Other - Last Name:BEEKMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1645 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-2554
Mailing Address - Country:US
Mailing Address - Phone:540-552-1246
Mailing Address - Fax:540-552-1247
Practice Address - Street 1:1645 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-2554
Practice Address - Country:US
Practice Address - Phone:540-552-1246
Practice Address - Fax:540-552-1247
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215126107Medicaid
VA022662F63Medicare PIN
P00818377Medicare PIN