Provider Demographics
NPI:1083113534
Name:HILL, SOPHIE M (FNP-C)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:M
Last Name:HILL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 AUDUBON LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4324
Mailing Address - Country:US
Mailing Address - Phone:936-635-9612
Mailing Address - Fax:
Practice Address - Street 1:818 W FRANK AVE
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3317
Practice Address - Country:US
Practice Address - Phone:936-699-5275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2022-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF01181090363LF0000X
TXAP136952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083113534OtherNPI
TXF01181090Medicaid