Provider Demographics
NPI:1285999615
Name:HALL, MIRANDA DIANE (APRN)
Entity type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:DIANE
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:617 23RD ST
Mailing Address - Street 2:SUITE415
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2880
Mailing Address - Country:US
Mailing Address - Phone:606-325-6888
Mailing Address - Fax:606-326-9368
Practice Address - Street 1:645 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1704
Practice Address - Country:US
Practice Address - Phone:606-474-0669
Practice Address - Fax:606-474-0376
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2024-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3007558363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner