Provider Demographics
NPI:1023631421
Name:HALL, HOLLEY ROBERSON (DNP, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:HOLLEY
Middle Name:ROBERSON
Last Name:HALL
Suffix:
Gender:F
Credentials:DNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 NORTH BENBOW RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27411-0001
Mailing Address - Country:US
Mailing Address - Phone:336-334-7880
Mailing Address - Fax:
Practice Address - Street 1:112 NORTH BENBOW RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27411-4300
Practice Address - Country:US
Practice Address - Phone:336-334-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014624363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health