Provider Demographics
NPI:1548679244
Name:HALL, JOHN VINCENT JR (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:VINCENT
Last Name:HALL
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 S SHIVERS ST
Mailing Address - Street 2:
Mailing Address - City:POPLARVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39470-3225
Mailing Address - Country:US
Mailing Address - Phone:601-270-0038
Mailing Address - Fax:
Practice Address - Street 1:64167 HIGHWAY 41 STE C
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:LA
Practice Address - Zip Code:70452-3638
Practice Address - Country:US
Practice Address - Phone:985-250-9700
Practice Address - Fax:844-899-5208
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR889798363LF0000X
LAAP08096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2409964Medicaid