Provider Demographics
NPI:1912931064
Name:LEE HALL, CARRIE R (CNM, WHCNP, FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:R
Last Name:LEE HALL
Suffix:
Gender:F
Credentials:CNM, WHCNP, FNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:R
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM, WHCNP, FNP
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:WHITESBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41858-0040
Mailing Address - Country:US
Mailing Address - Phone:606-633-4871
Mailing Address - Fax:606-633-1874
Practice Address - Street 1:226 MEDICAL PLAZA LN
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:KY
Practice Address - Zip Code:41858-7425
Practice Address - Country:US
Practice Address - Phone:606-633-4871
Practice Address - Fax:606-633-1874
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004904176B00000X, 363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017944Medicaid