Individual
KELLY RUTH HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
605 N MINE ST, SANDOVAL, IL 62882-1103
(618) 322-6680
Mailing address
605 N MINE ST, SANDOVAL, IL 62882-1103
(618) 322-6680
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209019672
IL
Other
Enumeration date
08/15/2019
Last updated
02/02/2025
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