Provider Demographics
NPI:1992257703
Name:HALL, KATHERINE R (APRN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:1624 MAIN STREET
Mailing Address - Street 2:DBA LTC HEALTH SOLUTIONS
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2818
Mailing Address - Country:US
Mailing Address - Phone:803-726-2350
Mailing Address - Fax:803-753-9102
Practice Address - Street 1:11 TODD DRIVE
Practice Address - Street 2:DBA LTC HEALTH SOLUTIONS
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:843-353-2581
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2018-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC20558363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4211Medicaid