Provider Demographics
NPI:1982038766
Name:HALL, JAMIE KELENE (APRN)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:KELENE
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:K
Other - Last Name:GILSTRAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 N ROCK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3973
Mailing Address - Country:US
Mailing Address - Phone:316-641-7965
Mailing Address - Fax:316-358-7758
Practice Address - Street 1:320 N ROCK RD STE 200
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3973
Practice Address - Country:US
Practice Address - Phone:316-352-7006
Practice Address - Fax:316-358-7758
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS76100363L00000X, 363LF0000X
KS90125163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse