Provider Demographics
NPI:1568036226
Name:BALL, LESLIE LYNN (FNP)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:LYNN
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MARSHALL HWY
Mailing Address - Street 2:
Mailing Address - City:WAR
Mailing Address - State:WV
Mailing Address - Zip Code:24892-7053
Mailing Address - Country:US
Mailing Address - Phone:304-875-2302
Mailing Address - Fax:
Practice Address - Street 1:402 MARSHALL HWY
Practice Address - Street 2:
Practice Address - City:WAR
Practice Address - State:WV
Practice Address - Zip Code:24892-7053
Practice Address - Country:US
Practice Address - Phone:304-875-2302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178493363LF0000X
WV110302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily