Provider Demographics
NPI:1326112665
Name:HALL, MARY M (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:TX
Mailing Address - Zip Code:76634-0549
Mailing Address - Country:US
Mailing Address - Phone:254-675-8322
Mailing Address - Fax:254-675-2246
Practice Address - Street 1:101 S AVENUE T
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:TX
Practice Address - Zip Code:76634-1832
Practice Address - Country:US
Practice Address - Phone:254-675-8322
Practice Address - Fax:254-675-2246
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX460232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00422880Medicare PIN
TX8J1742Medicare PIN
S55726Medicare UPIN