Basic Information
| Provider Information | |||||||||
| NPI: | 1053863688 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALL | ||||||||
| FirstName: | CRYSTAL | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 GRANVILLE MEADOW DR | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242664340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767917127 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17285 VETERANS MEMORIAL HWY | ||||||||
| Address2: | |||||||||
| City: | DUNGANNON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242453937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2764672201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2016 | ||||||||
| LastUpdateDate: | 04/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024174186 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.