MEDICARE: KAYLYN HALL RN

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	163WH0200X	Home Health Registered Nurse	83753	WV

General Provider Information

NPI Number	:	1902515323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLYN HALL RN

Provider Business Mailing Address
First Line	:	25 STONE LAKE DR
Second Line	:
City	:	ROANOKE
State	:	WV
Zip	:	26447-8440
Country	:	US
Telephone Number	:	304-644-7490
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 STONE LAKE DR
Second Line	:
City	:	ROANOKE
State	:	WV
Zip	:	26447-8440
Country	:	US
Telephone Number	:	304-644-7490
Fax Number	:

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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