Provider Demographics
NPI:1437707478
Name:HALL, ETHAN JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:JAMES
Last Name:HALL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2650 STRAWBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1553
Mailing Address - Country:US
Mailing Address - Phone:270-903-2102
Mailing Address - Fax:
Practice Address - Street 1:1633 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3423
Practice Address - Country:US
Practice Address - Phone:615-547-6930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant