Provider Demographics
NPI:1366256463
Name:HALL, MAKENZIE ANNE (ACNP-AG)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:ANNE
Last Name:HALL
Suffix:
Gender:F
Credentials:ACNP-AG
Other - Prefix:
Other - First Name:MAKENZIE
Other - Middle Name:ANNE
Other - Last Name:ROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1117 E NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-1232
Mailing Address - Country:US
Mailing Address - Phone:812-691-3777
Mailing Address - Fax:
Practice Address - Street 1:1606 N 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2706
Practice Address - Country:US
Practice Address - Phone:812-691-3777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28260410A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner