Provider Demographics
NPI:1306445846
Name:BALL, STEPHANIE LEANN (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEANN
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 BELFAST SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-8217
Mailing Address - Country:US
Mailing Address - Phone:276-971-8510
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3614
Practice Address - Country:US
Practice Address - Phone:615-679-9087
Practice Address - Fax:615-235-9725
Is Sole Proprietor?:No
Enumeration Date:2020-10-24
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1306445846Medicaid