Malissa Hallahan

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

NP95013990 Issued in CA

Practice address

1500 Florida Ave
Modesto, CA 95350-4408

Phone

(866) 682-4842

Fax

(877) 435-6573

NPI assigned

Apr 13, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1003379207",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 W CHILDS AVE",
            "city": "MERCED",
            "state": "CA",
            "postal_code": "953416805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 FLORIDA AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504408",
            "telephone_number": "866-682-4842",
            "fax_number": "877-435-6573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLAHAN",
        "first_name": "MALISSA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-13",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0102X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Maternal Newborn",
            "state": "AL",
            "license": "1-141039",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP95013990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judy Garland Hall
• Ryann June Hall
• Thomas Arnold Hall, PH.D.
• Thomas Lathrop Hall, MD
• Tommie Keith Hall II
• Amayah Tiann Hallam
• Nathan Hallam, PA
• Sarah Hallberg, PTA
• Amy Michelle Halley, MPT
• Brenna Leann Halliday

• Nurse Practitioner in Modesto, CA
• Providers in Modesto, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.