MEDICARE: STACY L HALL RN, NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	137912	TN
2	363LA2200X	Adult Health Nurse Practitioner	13102	TN

General Provider Information

NPI Number	:	1346433489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY L HALL RN, NP

Provider Business Mailing Address
First Line	:	1 BETHEL VALLEY RD
Second Line	:	PO BOX 2008, MS 6220
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-8050
Country	:	US
Telephone Number	:	865-574-7431
Fax Number	:	865-576-5381

Provider Business Practice Location Address
First Line	:	1 BETHEL VALLEY RD
Second Line	:	ORNL, MS 6220
City	:	OAK RIDGE
State	:	TN
Zip	:	37830-8050
Country	:	US
Telephone Number	:	865-574-7431
Fax Number	:	865-576-5381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	02/21/2022

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