Provider Demographics
NPI:1609822261
Name:HALL, LINDA FAY (APRN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:FAY
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:FAY
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-6000
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:1001 SAINT JOSEPH LN
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-8345
Practice Address - Country:US
Practice Address - Phone:606-330-6000
Practice Address - Fax:606-330-7825
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3931A367500000X
KY3931P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100112600Medicaid
KY78011111Medicaid
KY78011111Medicaid