Basic Information
| Provider Information | |||||||||
| NPI: | 1831396985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366949331 | ||||||||
| FaxNumber: | 3366947511 | ||||||||
| Practice Location | |||||||||
| Address1: | 439 US HIGHWAY 158 W | ||||||||
| Address2: | |||||||||
| City: | YANCEYVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273798304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3366949331 | ||||||||
| FaxNumber: | 3366947511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2007 | ||||||||
| LastUpdateDate: | 09/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 170580 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 0017138446 | 01 | VA | FNP AUTH TO PRESC- VA | OTHER | 0024166710 | 01 | VA | FNP LICENSE - VA | OTHER | 201926 | 01 | NC | APPROVAL TO PRACTICE AS A NURSE PRACTITIONER | OTHER | MM1148065 | 01 | DEA NUMBER | OTHER |