Provider Demographics
NPI:1306470786
Name:HALL, AMBER LYNN (LPN)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0967
Mailing Address - Country:US
Mailing Address - Phone:870-368-4587
Mailing Address - Fax:870-368-4587
Practice Address - Street 1:889 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-8205
Practice Address - Country:US
Practice Address - Phone:870-368-4587
Practice Address - Fax:870-368-4587
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARLTP-010732164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse