Provider Demographics
NPI:1912050758
Name:BALL, AMY C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:BALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1535 GULL RD
Mailing Address - Street 2:STE 105
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49048-1630
Mailing Address - Country:US
Mailing Address - Phone:269-969-6217
Mailing Address - Fax:269-969-8701
Practice Address - Street 1:3770 CAPITAL AVE SW STE B
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-9411
Practice Address - Country:US
Practice Address - Phone:269-441-1776
Practice Address - Fax:269-441-1774
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004406363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601004406OtherPHYSICIAN ASST LICENSE
MI5601004406OtherPHYSICIAN ASST LICENSE
MIQ55717Medicare UPIN