Provider Demographics
NPI:1760122311
Name:HALL, JAID NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:JAID
Middle Name:NICOLE
Last Name:HALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAUSHEC PSYCHIATRY RESIDENCY WILFORD HALL MEDICAL CENTE
Mailing Address - Street 2:1100 WILFORD HALL LOOP
Mailing Address - City:LACKLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 S CAROLINA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-3703
Practice Address - Country:US
Practice Address - Phone:214-668-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider