Healthcare Provider Details

I. General information

NPI: 1679492508
Provider Name (Legal Business Name): KATHERINE WAINRIGHT HALL DNP, APRN, FBP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3969 4TH AVE STE 203
SAN DIEGO CA
92103-3165
US

IV. Provider business mailing address

4847 PARKS AVE APT 24
LA MESA CA
91942-8666
US

V. Phone/Fax

Practice location:
  • Phone: 619-294-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95040578
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: