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General NPI Number Information
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NPI Number | 1306470786
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Entity Type | Individual
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Provider Name | AMBER LYNN HALL LPN
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Gender | Female
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Dates
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Enumeration Date | 02/25/2020
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Last Update Date | 02/25/2020
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Provider Practice Location Address
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Address Line | 889 MAIN ST
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City | MELBOURNE
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State | AR
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Zip | 72556-8205
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Country | US
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Telephone | 870-368-4587
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Fax | 870-368-4587
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Provider Business Mailing Address
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Address Line | PO BOX 967
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City | MELBOURNE
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State | AR
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Zip | 72556-0967
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Country | US
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Telephone | 870-368-4587
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Fax | 870-368-4587
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | LTP-010732
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License Number State | AR
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