MEDICARE: MRS. STACY HALL FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	API140837	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386202935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY HALL FNP-C

Provider Business Mailing Address
First Line	:	16848 W LAKE HOUSTON PKWY
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-4367
Country	:	US
Telephone Number	:	832-914-7079
Fax Number	:

Provider Business Practice Location Address
First Line	:	19875 SOUTHWEST FWY STE 110
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3502
Country	:	US
Telephone Number	:	281-545-2226
Fax Number	:	281-545-2231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	06/11/2019

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