Individual
MARYANN HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
77 MILLARD ALLEN DR, LACKEY, KY 41643
(606) 358-2381
(606) 358-2404
Mailing address
PO BOX 190, LACKEY, KY 41643-0190
(606) 358-2381
(606) 358-2404
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA781
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000313658
BCBS
—
01
—
000001207618
CHA
—
05
—
95004073
—
KY
Enumeration date
07/12/2005
Last updated
07/16/2008
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