Provider Demographics
NPI:1487994265
Name:BALL, EMILIE MARGARET (NP)
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:MARGARET
Last Name:BALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 AMERICAN WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-8339
Mailing Address - Country:US
Mailing Address - Phone:901-271-9500
Mailing Address - Fax:901-271-9501
Practice Address - Street 1:4095 AMERICAN WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-8339
Practice Address - Country:US
Practice Address - Phone:901-271-9500
Practice Address - Fax:901-271-9501
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001201480163W00000X
TN17013363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ000690Medicaid
TNQ000690Medicaid