Healthcare Provider Details

I. General information

NPI: 1811461627
Provider Name (Legal Business Name): KENDRA NICOLE HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9575 KY ROUTE 122 STE 6
MC DOWELL KY
41647-6043
US

IV. Provider business mailing address

9575 KY ROUTE 122 STE 6
MC DOWELL KY
41647-6043
US

V. Phone/Fax

Practice location:
  • Phone: 606-949-1623
  • Fax:
Mailing address:
  • Phone: 606-949-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3013125
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013125
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: