Provider Demographics
NPI:1881825776
Name:HALL, CLARISSA DOUGLASS (CRNP)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:DOUGLASS
Last Name:HALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 KELLER PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSCUMBIA
Mailing Address - State:AL
Mailing Address - Zip Code:35674-1417
Mailing Address - Country:US
Mailing Address - Phone:256-381-6963
Mailing Address - Fax:256-381-6018
Practice Address - Street 1:234 KELLER PARK BLVD
Practice Address - Street 2:
Practice Address - City:TUSCUMBIA
Practice Address - State:AL
Practice Address - Zip Code:35674-1417
Practice Address - Country:US
Practice Address - Phone:256-381-6963
Practice Address - Fax:256-381-6018
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-063875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily