Provider Demographics
NPI:1134520901
Name:HALL, KRISTI (APRN)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41666-0054
Mailing Address - Country:US
Mailing Address - Phone:606-531-4040
Mailing Address - Fax:606-284-2039
Practice Address - Street 1:484 TOLLAGE CRK
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3305
Practice Address - Country:US
Practice Address - Phone:606-230-2255
Practice Address - Fax:606-437-3001
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1134520901Medicaid
WV1134520901Medicaid
KY7100318780Medicaid