Provider Demographics
NPI:1558906313
Name:BALL, ALECIA SHEREE
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:SHEREE
Last Name:BALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 HARVEST ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-2034
Mailing Address - Country:US
Mailing Address - Phone:804-577-3874
Mailing Address - Fax:857-270-7149
Practice Address - Street 1:733 THIMBLE SHOALS BLVD STE 170
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4260
Practice Address - Country:US
Practice Address - Phone:757-810-7572
Practice Address - Fax:857-270-7149
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179027363LG0600X, 363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health