Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2017017883 | MO |
NPI | 1013446665 |
---|---|
Provider Name | Jamie Nicole Ball |
First Address | Kansas City, KS 66103-3171 |
Second Address | Lees Summit, MO 64086-5594 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 19/05/2021 |