=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164117370
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HALI ADAMS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2023
-----------------------------------------------------
Last Update Date | 04/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1337 HIGHWAY 119 N
-----------------------------------------------------
City | WHITESBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41858-7952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-403-1041
-----------------------------------------------------
Fax | 606-403-1000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1337 HIGHWAY 119 N
-----------------------------------------------------
City | WHITESBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41858-7952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-403-1041
-----------------------------------------------------
Fax | 606-403-1000
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 4000948
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------