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NPI Code Detail

MEDICARE: KRYSTAL HALL MEDICAL PROFESSIONAL, PLLC

MEDICARE: KRYSTAL HALL MEDICAL PROFESSIONAL, PLLC
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
1363LF0000XFamily Nurse PractitionerARNP3248772FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962739813
Entity Type Code : Organization
Provider Name (Legal Business Name) : KRYSTAL HALL MEDICAL PROFESSIONAL, PLLC
Provider Business Mailing Address
First Line : 38 S BLUE ANGEL PKWY # 104
Second Line :
City : PENSACOLA
State : FL
Zip : 32506-6045
Country : US
Telephone Number : 850-456-4082
Fax Number :
Provider Business Practice Location Address
First Line : 6984 PINE FOREST RD
Second Line :
City : PENSACOLA
State : FL
Zip : 32526-8908
Country : US
Telephone Number : 850-456-4082
Fax Number :
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : MRS. KRYSTAL S HALL
Credential : ARNP
Telephone Number : 850-529-7932
Provider Enumeration Date : 11/13/2009
Last Update Date : 02/04/2016

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