Healthcare Provider Details

I. General information

NPI: 1912430612
Provider Name (Legal Business Name): ABIGAIL HALLERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 03/18/2023
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 HOSPITAL DR
SHELBYVILLE KY
40065-1660
US

IV. Provider business mailing address

727 HOSPITAL DR
SHELBYVILLE KY
40065-1660
US

V. Phone/Fax

Practice location:
  • Phone: 502-647-4170
  • Fax:
Mailing address:
  • Phone: 502-647-4170
  • Fax: 502-633-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2020032474
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55604
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: