Provider Demographics
NPI:1699381434
Name:HALL, LEA ANN
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ANN
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 1:1101 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4815
Mailing Address - Country:US
Mailing Address - Phone:918-426-7800
Mailing Address - Fax:918-426-5837
Practice Address - Street 1:1407 NE D ST STE B
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2815
Practice Address - Country:US
Practice Address - Phone:918-967-8491
Practice Address - Fax:918-967-2552
Is Sole Proprietor?:No
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist