Provider Demographics
NPI:1609383082
Name:HALL, MICHAEL LYNN (DNPC APRN FNP PMHNP)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:M
Credentials:DNPC APRN FNP PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38025-0065
Mailing Address - Country:US
Mailing Address - Phone:731-316-1223
Mailing Address - Fax:731-903-7006
Practice Address - Street 1:728 N SAMPSON AVE
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-3962
Practice Address - Country:US
Practice Address - Phone:731-445-2887
Practice Address - Fax:731-903-7006
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-06
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23860363L00000X, 363LP0808X
TNAPN0000023860363LF0000X
KY3015473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ044081Medicaid
KY7100706230Medicaid