Provider Demographics
NPI:1972340982
Name:HALL, KHARA RENEE
Entity type:Individual
Prefix:
First Name:KHARA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 PARKBROOK TRAIL
Mailing Address - Street 2:C5
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35215
Mailing Address - Country:US
Mailing Address - Phone:205-542-3465
Mailing Address - Fax:
Practice Address - Street 1:851 PARKBROOK TRAIL
Practice Address - Street 2:C5
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35215
Practice Address - Country:US
Practice Address - Phone:205-542-3465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty