Provider Demographics
NPI:1154049823
Name:HALL, CARRIE SIZEMORE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:SIZEMORE
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MIRACLE VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:ENNICE
Mailing Address - State:NC
Mailing Address - Zip Code:28623-9235
Mailing Address - Country:US
Mailing Address - Phone:336-466-2843
Mailing Address - Fax:
Practice Address - Street 1:104 CRANBERRY RD STE 200A
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-0009
Practice Address - Country:US
Practice Address - Phone:276-236-9953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner