=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316763527
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY G HALE FNP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2024
-----------------------------------------------------
Last Update Date | 12/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 206 E MAIN ST
-----------------------------------------------------
City | OAK GROVE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71263-2557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-501-9025
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 268 QUARTER HORSE LN
-----------------------------------------------------
City | PIONEER
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71266-9411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-282-6849
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMY G HALE
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 318-282-6849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------