1518609528 NPI number — WENDY KAYE HALL RN-C, CLC

Table of content: WENDY KAYE HALL RN-C, CLC (NPI 1518609528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518609528 NPI number — WENDY KAYE HALL RN-C, CLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
WENDY
Provider Middle Name:
KAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN-C, CLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518609528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12346 WHITE OAK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39503-4765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-236-5608
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12346 WHITE OAK CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-4765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-236-5608
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WN0003X , with the licence number:  R887113 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WL0100X , with the licence number: R887113 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 336504 . This is a "ACADEMY OF LACTATION AND POLICY PRACTICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: R887113 . This is a "MISSISSIPPI STATE BOARD OF NURSING" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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