Provider Demographics
NPI:1588757959
Name:HALL, PATRICIA M (ARNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:M
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:4307 S WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4307 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5215
Practice Address - Country:US
Practice Address - Phone:509-585-8292
Practice Address - Fax:509-585-2484
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005388363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635228Medicaid
WA4593850001Medicare NSC
WAGAB28037Medicare PIN
WAS92730Medicare UPIN