Healthcare Provider Details

I. General information

NPI: 1013692821
Provider Name (Legal Business Name): LISA MARIE HALL MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAN O WAR BLVD
UNION KY
41091-2017
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-6324
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-5667
  • Fax: 859-384-0321
Mailing address:
  • Phone: 859-578-5667
  • Fax: 859-384-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3016412
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0033470
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: