Provider Demographics
NPI:1265928766
Name:HALL, NATHANA D (APRN NP-C)
Entity type:Individual
Prefix:
First Name:NATHANA
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1303
Mailing Address - Country:US
Mailing Address - Phone:606-475-0014
Mailing Address - Fax:833-944-0284
Practice Address - Street 1:201 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1303
Practice Address - Country:US
Practice Address - Phone:606-475-0014
Practice Address - Fax:833-944-0284
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2021-08-26
Deactivation Date:2020-05-28
Deactivation Code:
Reactivation Date:2020-06-22
Provider Licenses
StateLicense IDTaxonomies
KY3012447363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3012447OtherAPRN LICENSE NUMBER KY BON
KY7100626810Medicaid