Healthcare Provider Details

I. General information

NPI: 1295572329
Provider Name (Legal Business Name): JERED ALLEN HALL FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 OLD ROSEBUD RD STE 351
LEXINGTON KY
40509-8003
US

IV. Provider business mailing address

2716 OLD ROSEBUD RD STE 351
LEXINGTON KY
40509-8003
US

V. Phone/Fax

Practice location:
  • Phone: 859-543-1577
  • Fax: 859-543-1637
Mailing address:
  • Phone: 859-543-1577
  • Fax: 859-543-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4024227
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: