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General NPI Number Information
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NPI Number | 1245238518
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Entity Type | Individual
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Provider Name | MARYANN HALL PAC
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 77 MILLARD ALLEN DR
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City | LACKEY
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State | KY
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Zip | 41643
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Country | US
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Telephone | 606-358-2381
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Fax | 606-358-2404
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | LACKEY
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State | KY
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Zip | 41643-0190
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Country | US
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Telephone | 606-358-2381
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Fax | 606-358-2404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA781
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License Number State | KY
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