Provider Demographics
NPI:1275044513
Name:HALL, MEREDITH ELLEN (PA)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ELLEN
Last Name:HALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:KY
Mailing Address - Zip Code:42459-1630
Mailing Address - Country:US
Mailing Address - Phone:270-374-4040
Mailing Address - Fax:270-374-4045
Practice Address - Street 1:412 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:KY
Practice Address - Zip Code:42459-1630
Practice Address - Country:US
Practice Address - Phone:270-374-4040
Practice Address - Fax:270-374-4045
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA2324363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10002342AOtherINDIANA LICENSE