Mary Lydia Hall, AGPCNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

903270 Issued in MS

Practice address

501 Avalon Way Ste C
Brandon, MS 39047-7500

Phone

(601) 573-7012

NPI assigned

Mar 21, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Medical Consultants LLC

  • Primary Care Nurse Practitioner
  • Ridgeland, MS
  • NPI 1215396577
  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  MS

  Medicare reassignment NPD

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

{
    "created_epoch": "1553126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1902366495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 CEDAR HILL DR",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390563701",
            "telephone_number": "601-594-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 AVALON WAY STE C",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390477500",
            "telephone_number": "601-573-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "MARY",
        "middle_name": "LYDIA",
        "name_prefix": "Mrs.",
        "credential": "AGPCNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-03-21",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MS",
            "license": "903270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Bruce Guy II, FNP-C
• GW Pharmacy LLC
• Johnny Roy Hales
• Brittany Lauren Hall, FNP-C
• Garrett Hall, DMD
• Mollie Hall
• Selah Caroline Hall
• Tajma B Hall, RN
• Kenya Hamilton, CMHT
• Tabitha Sharieff Lashawn Hampton, LCSW

• Adult Health Nurse Practitioner in Brandon, MS
• Providers in Brandon, MS by specialty
• Adult Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.