Healthcare Provider Details

I. General information

NPI: 1164346144
Provider Name (Legal Business Name): MARISSA HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 STELLY LN
SULPHUR LA
70663-5134
US

IV. Provider business mailing address

2425 EVANGELINE OAK DR
SULPHUR LA
70665-8394
US

V. Phone/Fax

Practice location:
  • Phone: 337-794-6466
  • Fax:
Mailing address:
  • Phone: 337-794-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number248550
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: