Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5742 | KY |
Y | 213EG0000X | General Practice | 5742 | KY |
NPI | 1922123942 |
---|---|
Provider Name | Dr. Burnetta Lynn Hall |
First Address | Harold, KY 41635-0448 |
Second Address | Harold, KY 41635-9016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
60057429 | (05) | KY |