Provider Demographics
NPI:1821407289
Name:HALE, JEANETTE LYNN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:LYNN
Last Name:HALE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LUCKIE ST
Mailing Address - Street 2:STE F
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-0358
Mailing Address - Country:US
Mailing Address - Phone:912-366-1362
Mailing Address - Fax:912-366-1365
Practice Address - Street 1:277 LACKAWANNA ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-8072
Practice Address - Country:US
Practice Address - Phone:912-366-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154708363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily