Individual
JESSICA ALANA HALSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NPP
Contact information
Practice address
1205 TROY SCHENECTADY RD STE 101, LATHAM, NY 12110-1074
(518) 348-3176
(844) 574-2616
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
612519
NY
363L00000X
Nurse Practitioner
401466
NY
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
401466
NY
Other
Enumeration date
04/11/2012
Last updated
07/06/2021
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