Healthcare Provider Details

I. General information

NPI: 1548783285
Provider Name (Legal Business Name): KRIS L HALL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 ROAD G
ROLLA KS
67954-5503
US

IV. Provider business mailing address

311 ROAD G
ROLLA KS
67954-5503
US

V. Phone/Fax

Practice location:
  • Phone: 620-593-4347
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number6339726119
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: