Provider Demographics
NPI:1063836559
Name:WARD-HALL, KIMBERLY MICHELLE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:WARD-HALL
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 S MARLYN AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5945
Mailing Address - Country:US
Mailing Address - Phone:334-380-1357
Mailing Address - Fax:443-868-7455
Practice Address - Street 1:1277 S MARLYN AVE
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-5945
Practice Address - Country:US
Practice Address - Phone:334-380-1357
Practice Address - Fax:443-868-7455
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0002167363LA2100X
CA95003727363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care