Provider Demographics
NPI:1346449550
Name:HALL, KRISTEN A (APRN NP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5667
Mailing Address - Fax:864-512-6746
Practice Address - Street 1:2000 EAST GREENVILLE ST
Practice Address - Street 2:SUITE 1100
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1714
Practice Address - Country:US
Practice Address - Phone:864-512-5667
Practice Address - Fax:864-512-6746
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3293363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
3293OtherMED LICENSE
SCNP1132Medicaid
SCNP1132Medicaid
SCAA23408607Medicare UPIN