MEDICARE: COBA LANNA HALL FNP-BC

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	363LF0000X	Family Nurse Practitioner	31497	TN

General Provider Information

NPI Number	:	1902533540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COBA LANNA HALL FNP-BC

Provider Business Mailing Address
First Line	:	3226 KAYLEE LN
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-5829
Country	:	US
Telephone Number	:	865-809-5243
Fax Number	:

Provider Business Practice Location Address
First Line	:	3226 KAYLEE LN
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37664-5829
Country	:	US
Telephone Number	:	865-809-5243
Fax Number	:

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

Provider Enumeration Date	:	08/03/2022
Last Update Date	:	08/03/2022

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Directions to “ COBA LANNA HALL FNP-BC” Practice Location

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