Provider Demographics
NPI:1003496498
Name:HALL, KAITLYN ANNE
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 MONTREAT PKWY
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-3953
Mailing Address - Country:US
Mailing Address - Phone:573-291-2185
Mailing Address - Fax:
Practice Address - Street 1:2114 MONTREAT PKWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-3953
Practice Address - Country:US
Practice Address - Phone:573-291-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-173588163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse