Provider Demographics
NPI:1942940531
Name:HALL, KATHY LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:KATHY
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1447
Mailing Address - Country:US
Mailing Address - Phone:765-463-2571
Mailing Address - Fax:765-463-9401
Practice Address - Street 1:1051 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1447
Practice Address - Country:US
Practice Address - Phone:765-463-2571
Practice Address - Fax:765-463-9401
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28156083A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse