Provider Demographics
NPI:1922879519
Name:HALL, KAITLYN AMBER (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:AMBER
Last Name:HALL
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 MUNTJAC
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-6139
Mailing Address - Country:US
Mailing Address - Phone:928-750-3917
Mailing Address - Fax:
Practice Address - Street 1:3112 MUNTJAC
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-6139
Practice Address - Country:US
Practice Address - Phone:928-750-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXA-3814684171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach