Provider Demographics
NPI:1720474448
Name:HALL, KIM (CMT, TT)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:CMT, TT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HIGHWAY V V
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-0071
Mailing Address - Country:US
Mailing Address - Phone:573-359-2600
Mailing Address - Fax:573-359-1103
Practice Address - Street 1:925 HIGHWAY V V
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-0071
Practice Address - Country:US
Practice Address - Phone:573-359-2600
Practice Address - Fax:573-359-1103
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other