Provider Demographics
NPI:1104498096
Name:PEFFERKORN, HALLIE NICOL (BS)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:NICOL
Last Name:PEFFERKORN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 MANASSA CIR
Mailing Address - Street 2:
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520-5912
Mailing Address - Country:US
Mailing Address - Phone:337-354-7119
Mailing Address - Fax:
Practice Address - Street 1:102 MANASSA CIR
Practice Address - Street 2:
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520-5912
Practice Address - Country:US
Practice Address - Phone:337-354-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator