Healthcare Provider Details

I. General information

NPI: 1790751642
Provider Name (Legal Business Name): CONNIE HALE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3018 OLD MINDEN RD STE 1117
BOSSIER CITY LA
71112-2497
US

IV. Provider business mailing address

240 PICCADILLY CIR
BOSSIER CITY LA
71111-7127
US

V. Phone/Fax

Practice location:
  • Phone: 318-746-1935
  • Fax: 318-746-2514
Mailing address:
  • Phone: 318-422-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License NumberAP03832
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberAP03832
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03832
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP03832
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberAP03832
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: