Provider Demographics
NPI:1356415723
Name:HALL, RUTH A (RN, CPNP-AC, MHA)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:A
Last Name:HALL
Suffix:
Gender:F
Credentials:RN, CPNP-AC, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5864 HIDDEN MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-3635
Mailing Address - Country:US
Mailing Address - Phone:409-746-9201
Mailing Address - Fax:409-746-9204
Practice Address - Street 1:2300 MEDORA ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-1204
Practice Address - Country:US
Practice Address - Phone:337-437-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN112569 AP04749363LP0200X
TX453410363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics