Provider Demographics
NPI:1083363337
Name:HILLERY, MATTHEW (APRN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:HILLERY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2379
Mailing Address - Country:US
Mailing Address - Phone:937-651-6962
Mailing Address - Fax:
Practice Address - Street 1:1134 N MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2379
Practice Address - Country:US
Practice Address - Phone:937-651-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.420587163W00000X
OH0031510363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse