Healthcare Provider Details

I. General information

NPI: 1699698878
Provider Name (Legal Business Name): KATHERINE HALL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 BLOOMINGTON DR
BRIGHTON TN
38011-4092
US

IV. Provider business mailing address

61 BLOOMINGTON DR
BRIGHTON TN
38011-4092
US

V. Phone/Fax

Practice location:
  • Phone: 901-412-8494
  • Fax:
Mailing address:
  • Phone: 901-412-8494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026054738
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: