Provider Demographics
NPI:1730739996
Name:HALL, KATHLEEN NEVIN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NEVIN
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2472 PATTERSON RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1100
Mailing Address - Country:US
Mailing Address - Phone:970-628-0068
Mailing Address - Fax:970-628-0068
Practice Address - Street 1:2472 PATTERSON RD UNIT 5
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1100
Practice Address - Country:US
Practice Address - Phone:970-628-0068
Practice Address - Fax:970-628-0068
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1631576163WG0600X
COAPN.0991813-NP363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology