Provider Demographics
NPI:1003664293
Name:HALL, JENNY LYNNA' GIBBS (AG-ANCP-BC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNNA' GIBBS
Last Name:HALL
Suffix:
Gender:F
Credentials:AG-ANCP-BC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AG-ANCP-BC
Mailing Address - Street 1:704 PINNACLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37082-9212
Mailing Address - Country:US
Mailing Address - Phone:615-945-8890
Mailing Address - Fax:615-952-4870
Practice Address - Street 1:704 PINNACLE HILL RD
Practice Address - Street 2:
Practice Address - City:KINGSTON SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37082-9212
Practice Address - Country:US
Practice Address - Phone:615-945-8890
Practice Address - Fax:615-952-4870
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN00000027363363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care