Individual provider Active NPI

Shonve Ball, FNP

  • Family Nurse Practitioner
  • Pontotoc, MS
National Provider Identifier
1104200682
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R856364 Issued in MS
Practice address
166 Rough Wood Dr
Pontotoc, MS 38863-6076
Phone
(662) 509-0180
NPI assigned
Jul 15, 2015
Last updated
Sep 22, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R856364 MS Primary

Addresses

Primary practice location

166 Rough Wood Dr
Pontotoc, MS 38863-6076

Mailing address

166 Rough Wood Dr
Pontotoc, MS 38863-6076
Phone (662) 509-0180

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151105000357 MS Practitioner - Nurse Practitioner 7113237025 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R856364MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Boa Vida Hospital of Aberdeen, Ms LLC CurrentSince Nov 1, 2019 Accepting new patients
Redmed, LLC CurrentSince Sep 12, 2016 Accepting new patients
Redmed, LLC CurrentSince Sep 12, 2016 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC CurrentSince Nov 1, 2019 Accepting new patients

Locations

400 S Chestnut St
Aberdeen, MS 39730
Phone (662) 369-2455

12 Brookes Crossing
Pontotoc, MS 38863
Phone (662) 489-4044

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790035200000",
    "number": "1104200682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 ROUGH WOOD DR",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388636076",
            "telephone_number": "662-509-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 ROUGH WOOD DR",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388636076",
            "telephone_number": "662-509-0180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALL",
        "first_name": "SHONVE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-15",
        "last_updated": "2026-09-22",
        "certification_date": "2026-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R856364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pontotoc, MS

Sources for this page

Verify at the official NPI Registry.