Provider Demographics
NPI:1962797589
Name:HALL, HOLLIE ANN (ARNP-C)
Entity type:Individual
Prefix:MRS
First Name:HOLLIE
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-3049
Mailing Address - Country:US
Mailing Address - Phone:785-539-4644
Mailing Address - Fax:785-539-8010
Practice Address - Street 1:200 RESEARCH DR
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3049
Practice Address - Country:US
Practice Address - Phone:785-539-4644
Practice Address - Fax:785-539-8010
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75376-102363L00000X
TX1105844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200748830AMedicaid
111354008OtherMEDICARE