Provider Demographics
NPI:1598009839
Name:HALL, ABBY JO (CRNA)
Entity Type:Individual
Prefix:MS
First Name:ABBY
Middle Name:JO
Last Name:HALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1354 CONSER ST
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-4072
Mailing Address - Country:US
Mailing Address - Phone:314-362-6973
Mailing Address - Fax:314-747-5157
Practice Address - Street 1:410 N CEDAR BLUFF RD
Practice Address - Street 2:SUITE 300
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3623
Practice Address - Country:US
Practice Address - Phone:865-342-8900
Practice Address - Fax:865-691-0843
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2013001724367500000X
TN19259367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid