Provider Demographics
NPI:1073121240
Name:BALL, KRISTEN ALLEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALLEN
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 HIDDEN FIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9463
Mailing Address - Country:US
Mailing Address - Phone:757-763-8951
Mailing Address - Fax:
Practice Address - Street 1:1104 HIDDEN FIELDS WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-9463
Practice Address - Country:US
Practice Address - Phone:757-763-8951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC227417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse