Provider Demographics
NPI:1114702636
Name:HALL, PAMELA LYNETTE (MSN,APRN,PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LYNETTE
Last Name:HALL
Suffix:
Gender:F
Credentials:MSN,APRN,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6866 MORRISON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71119
Mailing Address - Country:US
Mailing Address - Phone:318-426-0172
Mailing Address - Fax:
Practice Address - Street 1:1495 FRAZIER RD
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1632
Practice Address - Country:US
Practice Address - Phone:318-202-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA232162363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health