Provider Demographics
NPI:1699136341
Name:HALL, MEHREEN SHEIKH (DO)
Entity type:Individual
Prefix:
First Name:MEHREEN
Middle Name:SHEIKH
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
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 2400
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42241-2400
Mailing Address - Country:US
Mailing Address - Phone:270-887-6843
Mailing Address - Fax:
Practice Address - Street 1:10755 EAGLE WAY STE 202
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8742
Practice Address - Country:US
Practice Address - Phone:270-887-5640
Practice Address - Fax:270-886-5371
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05299207N00000X, 207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100839050Medicaid
14659132OtherCAQH