MEDICARE: ALYSSA HALL AGNP-C

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	RN732095	PA
2	363LA2200X	Adult Health Nurse Practitioner	312004	NY

General Provider Information

NPI Number	:	1992548499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA HALL AGNP-C

Provider Business Mailing Address
First Line	:	3 GUTHRIE DR
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-3696
Country	:	US
Telephone Number	:	607-973-8000
Fax Number	:	570-887-6805

Provider Business Practice Location Address
First Line	:	3 GUTHRIE DR
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-3696
Country	:	US
Telephone Number	:	607-973-8000
Fax Number	:

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

Provider Enumeration Date	:	06/13/2024
Last Update Date	:	03/18/2026

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