Provider Demographics
NPI:1225500630
Name:BALL, KURTAVIOUS V SR (MMC, PA-C)
Entity Type:Individual
Prefix:MR
First Name:KURTAVIOUS
Middle Name:V
Last Name:BALL
Suffix:SR
Gender:M
Credentials:MMC, PA-C
Other - Prefix:
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Mailing Address - Street 1:42 HEATHER CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1542
Mailing Address - Country:US
Mailing Address - Phone:267-966-7604
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-23
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
PAMA060502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant