1316928708 NPI number — MS. WANDA NEWBY HILL DNP FNP, FPMHNP-BC

Table of content: MS. WANDA NEWBY HILL DNP FNP, FPMHNP-BC (NPI 1316928708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316928708 NPI number — MS. WANDA NEWBY HILL DNP FNP, FPMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILL
Provider First Name:
WANDA
Provider Middle Name:
NEWBY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DNP FNP, FPMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILL
Provider Other First Name:
WANDA
Provider Other Middle Name:
J.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, NP, FNP, FPMHNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316928708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72A COUNTY ROAD 421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TISHOMINGO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38873-8728
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-438-7226
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 ALCORN DRIVE
Provider Second Line Business Practice Location Address:
CROSSROADS CENTER
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38834-9321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-293-4280
Provider Business Practice Location Address Fax Number:
662-293-4282
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R850602 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05083051 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com