Provider Demographics
NPI:1225323595
Name:HALL, LATRISHA A (DO)
Entity Type:Individual
Prefix:
First Name:LATRISHA
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1014 HARKRIDER ST
Mailing Address - Street 2:STE B
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-4404
Mailing Address - Country:US
Mailing Address - Phone:501-327-7100
Mailing Address - Fax:501-327-7121
Practice Address - Street 1:1014 HARKRIDER ST
Practice Address - Street 2:STE B
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4404
Practice Address - Country:US
Practice Address - Phone:501-327-7100
Practice Address - Fax:501-327-7121
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2015-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-7745207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR196783003Medicaid
AR271404YT0BMedicare PIN