MEDICARE: DR KANISHA HALL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1366954588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KANISHA HALL PLLC

Provider Business Mailing Address
First Line	:	5315B CYPRESS CREEK PKWY # 193
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-4403
Country	:	US
Telephone Number	:	202-709-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S MAIN ST
Second Line	:
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-4544
Country	:	US
Telephone Number	:	202-709-9822
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KANISHA HALL
Credential	:	MD
Telephone Number	:	202-709-9822

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	05/08/2019

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