Healthcare Provider Details

I. General information

NPI: 1689396863
Provider Name (Legal Business Name): NICOLE BAILEY HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HOSPITAL DR
MADISON TN
37115-5030
US

IV. Provider business mailing address

315 HOSPITAL DR
MADISON TN
37115-5030
US

V. Phone/Fax

Practice location:
  • Phone: 615-732-7662
  • Fax:
Mailing address:
  • Phone: 615-732-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0000222086
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: