Doctor Name: | MRS. CARLA JO HALE |
NPI Number: | 1154315430 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PAC |
License Number: | PA325 |
Business Practice Address: | 411 S L Roger Wells Blvd Glasgow, KY - 421411191 |
Business Phone Number: | 2706517796 |
Business Fax Number: | 2706517074 |
Mailing Address: | 411 S L Roger Wells Blvd, GLASGOW |
State: | KY |
Postal Code: | 421411191 |
Phone Number: | 2706517796 |
Fax Number: | 2706517074 |
NPI Enumeration Date: | 09/01/2005 |
NPI Last Update Date: | 03/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA325 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |