Provider Demographics
NPI:1164704557
Name:HALL, AMBER RENEE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:RENEE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8010 STAGE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4032
Mailing Address - Country:US
Mailing Address - Phone:901-291-2400
Mailing Address - Fax:
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-5211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1977363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant