Provider Demographics
NPI:1538127691
Name:HALL, MELBA (APRN)
Entity Type:Individual
Prefix:
First Name:MELBA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MELBA
Other - Middle Name:
Other - Last Name:HOEPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-2273
Practice Address - Fax:573-884-4609
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN043704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO401483OtherHEALTHLINK
MO426924619Medicaid
MO401483OtherUNITED HEALTHCARE
KS4286899501OtherKANSAS MEDICAID
MO32957OtherBLUE SHIELD/BLUE CHOICE
MO401483OtherUNITED HEALTHCARE
R03271Medicare UPIN
MO834515236Medicare PIN
MO002080010Medicare PIN
KS4286899501OtherKANSAS MEDICAID