Provider Demographics
NPI:1891910188
Name:HALL, KAREN LEE (BS, MA, RN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:HALL
Suffix:
Gender:F
Credentials:BS, MA, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1962 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2004
Mailing Address - Country:US
Mailing Address - Phone:501-538-3459
Mailing Address - Fax:
Practice Address - Street 1:1962 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2004
Practice Address - Country:US
Practice Address - Phone:501-538-3459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01635363LF0000X
MSA810255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP01002546OtherRAILROAD MEDICARE
MS00884745Medicaid
MSP01020Medicare UPIN