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General NPI Number Information
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NPI Number | 1700661915
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Entity Type | Individual
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Provider Name | NICOLE RENEE HALL FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/28/2023
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 376 SIMPSON HIGHWAY 149 STE 300
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City | MAGEE
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State | MS
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Zip | 39111-3569
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Country | US
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Telephone | 601-721-8985
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Fax |
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Provider Business Mailing Address
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Address Line | 376 SIMPSON HIGHWAY 149 STE 300
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City | MAGEE
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State | MS
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Zip | 39111-3569
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Country | US
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Telephone | 601-721-8985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 906043
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License Number State | MS
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