Healthcare Provider Details

I. General information

NPI: 1376805143
Provider Name (Legal Business Name): RACHEL M HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 STATE ROUTE 3117
SOUTH SHORE KY
41175-9597
US

IV. Provider business mailing address

137 STATE ROUTE 3117
SOUTH SHORE KY
41175-9597
US

V. Phone/Fax

Practice location:
  • Phone: 606-932-2079
  • Fax: 606-932-2313
Mailing address:
  • Phone: 606-932-2079
  • Fax: 606-932-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007174
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number7100277720
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7100373960
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: