Provider Demographics
NPI:1790196434
Name:HALL, AUDREY LOUISE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LOUISE
Last Name:HALL
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 TURKEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-9612
Mailing Address - Country:US
Mailing Address - Phone:508-446-1787
Mailing Address - Fax:413-319-9369
Practice Address - Street 1:53 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3591
Practice Address - Country:US
Practice Address - Phone:413-341-0885
Practice Address - Fax:413-319-9369
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN279915363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health