Healthcare Provider Details

I. General information

NPI: 1245022029
Provider Name (Legal Business Name): AMBER RENEE HALL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S CREEK DR STE 112
MONTICELLO KY
42633-9472
US

IV. Provider business mailing address

1 S CREEK DR STE 112
MONTICELLO KY
42633-9472
US

V. Phone/Fax

Practice location:
  • Phone: 66-348-3341
  • Fax: --
Mailing address:
  • Phone: 606-348-3341
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4039337
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1181351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: