Provider Demographics
NPI:1518609528
Name:HALL, WENDY KAYE (RN-C, CLC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:KAYE
Last Name:HALL
Suffix:
Gender:F
Credentials:RN-C, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12346 WHITE OAK CT
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4765
Mailing Address - Country:US
Mailing Address - Phone:228-236-5608
Mailing Address - Fax:
Practice Address - Street 1:12346 WHITE OAK CT
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4765
Practice Address - Country:US
Practice Address - Phone:228-236-5608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR887113163WN0003X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
336504OtherACADEMY OF LACTATION AND POLICY PRACTICE
MSR887113OtherMISSISSIPPI STATE BOARD OF NURSING