Healthcare Provider Details

I. General information

NPI: 1962384099
Provider Name (Legal Business Name): CONNER LEE HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ROSE ST
LEXINGTON KY
40506-0001
US

IV. Provider business mailing address

2204 VINEWOOD RD # 324
LEXINGTON KY
40515-1244
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6161
  • Fax:
Mailing address:
  • Phone: 859-402-6349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: