Provider Demographics
NPI:1235437617
Name:HALL, SELINA (C-PNP)
Entity Type:Individual
Prefix:MISS
First Name:SELINA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 WIRT RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-2406
Mailing Address - Country:US
Mailing Address - Phone:713-468-9000
Mailing Address - Fax:713-468-9002
Practice Address - Street 1:1821 WIRT RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-2406
Practice Address - Country:US
Practice Address - Phone:713-468-9000
Practice Address - Fax:713-468-9002
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697440363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329430801Medicaid