Provider Demographics
NPI:1255917852
Name:HALL, ASHLIE LYNN (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:ASHLIE
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OK
Mailing Address - Zip Code:74724-0205
Mailing Address - Country:US
Mailing Address - Phone:187-219-3379
Mailing Address - Fax:
Practice Address - Street 1:26995 N US HIGHWAY 259
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OK
Practice Address - Zip Code:74724-7003
Practice Address - Country:US
Practice Address - Phone:189-721-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK201655363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care