Healthcare Provider Details

I. General information

NPI: 1477176642
Provider Name (Legal Business Name): STEPHANIE LEAH HALL RN, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE LEAH PETROSKEY HALL RT(R), PET, CNMT

II. Dates (important events)

Enumeration Date: 05/22/2020
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS AVE
BILOXI MS
39531-2410
US

IV. Provider business mailing address

6108 MOSSY OAK DR E
OCEAN SPRINGS MS
39564-8807
US

V. Phone/Fax

Practice location:
  • Phone: 662-523-5000
  • Fax:
Mailing address:
  • Phone: 662-660-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberS-82650
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number903626
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberMS-903626
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number024917
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number363070
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: