Healthcare Provider Details

I. General information

NPI: 1942940531
Provider Name (Legal Business Name): KATHY LYNN HALL REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CUMBERLAND AVE
WEST LAFAYETTE IN
47906-1447
US

IV. Provider business mailing address

1051 CUMBERLAND AVE
WEST LAFAYETTE IN
47906-1447
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-2571
  • Fax: 765-463-9401
Mailing address:
  • Phone: 765-463-2571
  • Fax: 765-463-9401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28156083A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: