Provider Demographics
NPI:1629802533
Name:BALL, AMBER LYNN (RN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:BALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-8940
Mailing Address - Country:US
Mailing Address - Phone:405-255-9509
Mailing Address - Fax:
Practice Address - Street 1:1224 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4416
Practice Address - Country:US
Practice Address - Phone:580-260-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0092134163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy