Healthcare Provider Details

I. General information

NPI: 1467684670
Provider Name (Legal Business Name): RAYNA HALL LMT, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 CLYO RD STE A
CENTERVILLE OH
45459-2785
US

IV. Provider business mailing address

6611 CLYO RD STE A
CENTERVILLE OH
45459-2785
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7300
  • Fax: 937-208-7330
Mailing address:
  • Phone: 937-208-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.414629
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number33.016347
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.016347
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0036427
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: