Healthcare Provider Details

I. General information

NPI: 1952722316
Provider Name (Legal Business Name): STACY HALL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2014
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 TECH CENTER DR
GAHANNA OH
43230-1987
US

IV. Provider business mailing address

1725 W CENTRAL AVE
DELAWARE OH
43015-1699
US

V. Phone/Fax

Practice location:
  • Phone: 614-396-2684
  • Fax: 614-396-2480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: