Provider Demographics
NPI:1093060436
Name:HILSON, SHANA T
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:T
Last Name:HILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TN
Mailing Address - Zip Code:37347-2808
Mailing Address - Country:US
Mailing Address - Phone:931-691-5101
Mailing Address - Fax:
Practice Address - Street 1:1115 DENNIS AVE
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347-2808
Practice Address - Country:US
Practice Address - Phone:931-691-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16866363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1530399Medicaid
GA003126073BMedicaid
TN4331413OtherBCBS
TN1530399Medicaid