Healthcare Provider Details

I. General information

NPI: 1326952540
Provider Name (Legal Business Name): CORY HALLUM NRP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BIG SINK RD
VERSAILLES KY
40383-1556
US

IV. Provider business mailing address

111 COLLINS PATH APT 1
GEORGETOWN KY
40324-8457
US

V. Phone/Fax

Practice location:
  • Phone: 270-871-5719
  • Fax:
Mailing address:
  • Phone: 270-871-5719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number1122984
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: