Healthcare Provider Details

I. General information

NPI: 1275044513
Provider Name (Legal Business Name): MEREDITH ELLEN HALL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N MAIN ST
STURGIS KY
42459-1630
US

IV. Provider business mailing address

412 N MAIN ST
STURGIS KY
42459-1630
US

V. Phone/Fax

Practice location:
  • Phone: 270-374-4040
  • Fax: 270-374-4045
Mailing address:
  • Phone: 270-374-4040
  • Fax: 270-374-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2324
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: