Provider Demographics
NPI:1457038036
Name:HALL, KRYSTAL ANN (CNM)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-1124
Mailing Address - Country:US
Mailing Address - Phone:352-361-8390
Mailing Address - Fax:
Practice Address - Street 1:1589 SPARTA ST STE 306
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1389
Practice Address - Country:US
Practice Address - Phone:931-815-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife