Provider Demographics
NPI:1023732914
Name:HALL, KIMBERLY LYNNE (DNP FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:HALL
Suffix:
Gender:F
Credentials:DNP FNP-BC
Other - Prefix:MS
Other - First Name:KIM
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP FNP-BC
Mailing Address - Street 1:320 MOCKINGBIRD GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5703
Mailing Address - Country:US
Mailing Address - Phone:502-500-5327
Mailing Address - Fax:
Practice Address - Street 1:411 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-2201
Practice Address - Fax:502-588-7776
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100870280Medicaid