Provider Demographics
NPI:1053661025
Name:BALL, NATALIE (PA)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:805 FARSON ST STE 117
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714
Practice Address - Country:US
Practice Address - Phone:740-401-0033
Practice Address - Fax:740-401-0039
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7103008000Medicaid
OH0072439Medicaid
OH0072439Medicaid
OHP01187383OtherRAILROAD MEDICARE
OHH160511Medicare PIN
WVWV2397AMedicare PIN
WVWV2397A655Medicare PIN