Provider Demographics
NPI:1043392814
Name:HALL, KIMBERLY RENE
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RENE
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 1:601 TURPIN RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:KY
Mailing Address - Zip Code:40336
Mailing Address - Country:US
Mailing Address - Phone:606-723-9147
Mailing Address - Fax:
Practice Address - Street 1:2006 MERCHANT DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8167
Practice Address - Country:US
Practice Address - Phone:859-626-7977
Practice Address - Fax:859-626-5103
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant