Provider Demographics
NPI:1346433489
Name:HALL, STACY L (RN, NP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BETHEL VALLEY RD
Mailing Address - Street 2:PO BOX 2008, MS 6220
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8050
Mailing Address - Country:US
Mailing Address - Phone:865-574-7431
Mailing Address - Fax:865-576-5381
Practice Address - Street 1:1 BETHEL VALLEY RD
Practice Address - Street 2:ORNL, MS 6220
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8050
Practice Address - Country:US
Practice Address - Phone:865-574-7431
Practice Address - Fax:865-576-5381
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN137912163W00000X
TN13102363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3341591Medicare PIN