Provider Demographics
NPI:1629378401
Name:HALL, DONITA LYNN (RN, MSN, APRN)
Entity type:Individual
Prefix:MRS
First Name:DONITA
Middle Name:LYNN
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, MSN, APRN
Other - Prefix:
Other - First Name:DONITA
Other - Middle Name:
Other - Last Name:MCDIFFETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4046
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-4046
Mailing Address - Country:US
Mailing Address - Phone:417-269-5712
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3525 S NATIONAL AVE STE 207
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7315
Practice Address - Country:US
Practice Address - Phone:417-269-9220
Practice Address - Fax:417-269-9229
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75237-102363LA2200X
MO2011001350363LF0000X, 363LA2200X
KS5375237102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily