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NPI Code Detail

MEDICARE: VANCE R HALE AGPCNP

MEDICARE: VANCE R HALE AGPCNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner67636NM
2363LA2200XAdult Health Nurse Practitioner1074020TX
3363LA2200XAdult Health Nurse Practitioner29979SC
4363LA2200XAdult Health Nurse PractitionerAPRN11033371FL
5363LA2200XAdult Health Nurse Practitioner321340AZ
6363LA2200XAdult Health Nurse Practitioner0024192139VA
7363LG0600XGerontology Nurse Practitioner1074020TX
8363LA2200XAdult Health Nurse Practitioner8559879NV

General Provider Information

NPI Number : 1780324442
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANCE R HALE AGPCNP
Provider Business Mailing Address
First Line : PO BOX 1000, DEPT 394
Second Line :
City : MEMPHIS
State : TN
Zip : 38148-0001
Country : US
Telephone Number : 941-300-4440
Fax Number : 941-404-1760
Provider Business Practice Location Address
First Line : 1820 E SAHARA AVE STE 201
Second Line :
City : LAS VEGAS
State : NV
Zip : 89104-3721
Country : US
Telephone Number : 702-979-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2022
Last Update Date : 06/16/2025

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