1902847163 NPI number — PATRICIA DANIELLE HALL C.P.N.P.

Table of content: PATRICIA DANIELLE HALL C.P.N.P. (NPI 1902847163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902847163 NPI number — PATRICIA DANIELLE HALL C.P.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
PATRICIA
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.P.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALL
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.P.N.P.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902847163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 NORTH STATE STREET
Provider Second Line Business Mailing Address:
JMM SUITE 2525
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216-4500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-815-9528
Provider Business Mailing Address Fax Number:
601-984-6439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12100 HIGHWAY 49
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-3063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-831-1988
Provider Business Practice Location Address Fax Number:
228-831-1978
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  R864001 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05802031 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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