Provider Demographics
NPI:1780855072
Name:BALL, TAMMY L (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:BALL
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-992-0060
Mailing Address - Fax:740-446-5154
Practice Address - Street 1:2131 E STATE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2138
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-589-3123
Is Sole Proprietor?:No
Enumeration Date:2008-03-14
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09955363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2821263Medicaid
OH000000236211OtherOH MEDICAID UNISON
WV3810011516Medicaid
OH310917085186OtherOH MEDICAID CARESOURCE
OH2821263OtherOH MEDICAID MOLINA
BANP26691Medicare PIN