Provider Demographics
NPI:1679033914
Name:HALL, MEGAN ANN LOUISE
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:ANN LOUISE
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 DALLAS STREET
Mailing Address - Street 2:
Mailing Address - City:TALIHINA
Mailing Address - State:OK
Mailing Address - Zip Code:74571
Mailing Address - Country:US
Mailing Address - Phone:918-413-2263
Mailing Address - Fax:918-567-3180
Practice Address - Street 1:908 DALLAS STREET
Practice Address - Street 2:
Practice Address - City:TALIHINA
Practice Address - State:OK
Practice Address - Zip Code:74571
Practice Address - Country:US
Practice Address - Phone:918-413-2263
Practice Address - Fax:918-567-3180
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000000000Medicaid