Basic Information
| Provider Information | |||||||||
| NPI: | 1992792477 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.N. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3422 PRYOR RD | ||||||||
| Address2: | |||||||||
| City: | COLDWATER | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386187742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622334958 | ||||||||
| FaxNumber: | 9013801340 | ||||||||
| Practice Location | |||||||||
| Address1: | 2606 CORPORATE AVE E | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381321708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013804404 | ||||||||
| FaxNumber: | 9013801340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WH0200X | R852397 | MS | Y | Nursing Service Providers | Registered Nurse | Home Health |
No ID Information.