Provider Demographics
NPI:1003804030
Name:HILL, CRYSTAL DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:DAWN
Last Name:HILL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7780 BRIER CREEK PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7869
Mailing Address - Country:US
Mailing Address - Phone:910-815-6114
Mailing Address - Fax:910-251-8824
Practice Address - Street 1:2421 SILVER STREAM LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7684
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-8824
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104188363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE0985OtherMEDCOST
NC104188OtherNC LICENSE
NC2762531Medicare PIN
NC104188OtherNC LICENSE