Provider Demographics
NPI:1407969017
Name:BALL, DEBORAH LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
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:RR 4 BOX 5000
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9720
Mailing Address - Country:US
Mailing Address - Phone:276-964-7481
Mailing Address - Fax:
Practice Address - Street 1:583C E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24630-9573
Practice Address - Country:US
Practice Address - Phone:276-979-9899
Practice Address - Fax:276-935-2889
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily