1477176642 NPI number — STEPHANIE LEAH HALL RN, CCRN

Table of content: STEPHANIE LEAH HALL RN, CCRN (NPI 1477176642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477176642 NPI number — STEPHANIE LEAH HALL RN, CCRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALL
Provider First Name:
STEPHANIE
Provider Middle Name:
LEAH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, CCRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PETROSKEY HALL
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LEAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RT(R), PET, CNMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477176642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6108 MOSSY OAK DR E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39564-8807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-660-8981
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 VETERANS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39531-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-523-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2020

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: 163WC0200X , with the licence number:  MS-903626 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207UN0902X , with the licence number: 024917 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2471C3402X , with the licence number: 363070 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 247200000X , with the licence number: S-82650 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 903626 , 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)