Healthcare Provider Details

I. General information

NPI: 1639052061
Provider Name (Legal Business Name): KYRA MARIE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E HANNA AVE
INDIANAPOLIS IN
46227-3630
US

IV. Provider business mailing address

353 SR 129 S
BATESVILLE IN
47006
US

V. Phone/Fax

Practice location:
  • Phone: 812-671-4178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: