Provider Demographics
NPI:1326540410
Name:BALL, CANDICE ELYSE (APRN)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:ELYSE
Last Name:BALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:ELYSE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9841 NORTHLAKE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-8930
Mailing Address - Country:US
Mailing Address - Phone:866-789-3737
Mailing Address - Fax:
Practice Address - Street 1:9841 NORTHLAKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-8930
Practice Address - Country:US
Practice Address - Phone:866-789-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012721363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily