Provider Demographics
NPI:1679243943
Name:HALL, KORI KAY (MSN, APRN-CNP, RN)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:KAY
Last Name:HALL
Suffix:
Gender:F
Credentials:MSN, APRN-CNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ANSELMI RD
Mailing Address - Street 2:
Mailing Address - City:BALD KNOB
Mailing Address - State:AR
Mailing Address - Zip Code:72010-9682
Mailing Address - Country:US
Mailing Address - Phone:501-278-7727
Mailing Address - Fax:
Practice Address - Street 1:707 W BEEBE CAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6303
Practice Address - Country:US
Practice Address - Phone:501-278-7727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR213178363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner