Provider Demographics
NPI:1902948938
Name:BALL, JEANICE RAE (CNM, WHNP)
Entity type:Individual
Prefix:
First Name:JEANICE
Middle Name:RAE
Last Name:BALL
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S FOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1325
Mailing Address - Country:US
Mailing Address - Phone:312-343-8967
Mailing Address - Fax:
Practice Address - Street 1:343 S FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1325
Practice Address - Country:US
Practice Address - Phone:312-343-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75363363LW0102X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health