Healthcare Provider Details

I. General information

NPI: 1972856227
Provider Name (Legal Business Name): MISS JUANITA HALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NITA HALE BSN

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LINVILLE DR
PARIS KY
40361-2128
US

IV. Provider business mailing address

837 CELIA LN
LEXINGTON KY
40504-2305
US

V. Phone/Fax

Practice location:
  • Phone: 859-321-8631
  • Fax:
Mailing address:
  • Phone: 859-321-8631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1075442
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: