Individual
KELLI DANIELLE GRIM HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10310 THE GROVE BLVD, BATON ROUGE, LA 70836-6455
(225) 761-5470
(225) 761-5549
Mailing address
10310 THE GROVE BLVD, BATON ROUGE, LA 70836-6455
(225) 761-5200
(225) 761-5549
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD.206157
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02784541
—
MS
05
—
2108158
—
LA
Enumeration date
04/15/2010
Last updated
08/28/2019
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