Healthcare Provider Details

I. General information

NPI: 1598009839
Provider Name (Legal Business Name): ABBY JO HALL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2012
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N CEDAR BLUFF RD SUITE 300
KNOXVILLE TN
37923-3623
US

IV. Provider business mailing address

1354 CONSER ST
COLLIERVILLE TN
38017-4072
US

V. Phone/Fax

Practice location:
  • Phone: 865-342-8900
  • Fax: 865-691-0843
Mailing address:
  • Phone: 314-362-6973
  • Fax: 314-747-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2013001724
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number19259
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: