Provider Demographics
NPI:1659756310
Name:HALL, CARRIE KEENAN (FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:KEENAN
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-C, APRN
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 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:1506 N LIMESTONE ST STE C
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4747
Practice Address - Country:US
Practice Address - Phone:864-487-4573
Practice Address - Fax:864-488-0966
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19610363LF0000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC6460H918OtherMEDICARE PIN
SCNP3455Medicaid
SCSC64606162OtherMEDICARE PIN
SCSC6460J577OtherMEDICARE PIN