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NPI Code Detail

MEDICARE: DR. AMY ROSE HALL PSY.D.

MEDICARE: DR. AMY ROSE HALL PSY.D.
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
1103T00000XPsychologist3373NC

General Provider Information

NPI Number : 1487677399
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. AMY ROSE HALL PSY.D.
Provider Business Mailing Address
First Line : 200 TARPON TRL
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5287
Country : US
Telephone Number : 910-938-1114
Fax Number :
Provider Business Practice Location Address
First Line : 200 TARPON TRL
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-5287
Country : US
Telephone Number : 910-938-1114
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 09/23/2010

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