Healthcare Provider Details

I. General information

NPI: 1285971366
Provider Name (Legal Business Name): BRIDGET DIANA HURT HALL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 3RD ST STE 200
CHATTANOOGA TN
37404-2745
US

IV. Provider business mailing address

8810 E RIDGE TRAIL RD
SODDY DAISY TN
37379-3460
US

V. Phone/Fax

Practice location:
  • Phone: 423-643-2500
  • Fax: 423-305-7822
Mailing address:
  • Phone: 423-802-5169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19547
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: