Provider Demographics
NPI:1083405344
Name:HALL, NICOSHA
Entity type:Individual
Prefix:
First Name:NICOSHA
Middle Name:
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 1:20008 CHAMPION FOREST DR STE 601
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8696
Mailing Address - Country:US
Mailing Address - Phone:713-819-6904
Mailing Address - Fax:
Practice Address - Street 1:20008 CHAMPION FOREST DR STE 601
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8696
Practice Address - Country:US
Practice Address - Phone:713-819-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator