Provider Demographics
NPI:1205023629
Name:HILDERBRAND, JIMMIE KENT
Entity Type:Individual
Prefix:MR
First Name:JIMMIE
Middle Name:KENT
Last Name:HILDERBRAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:HALFWAY
Mailing Address - State:OR
Mailing Address - Zip Code:97834-0711
Mailing Address - Country:US
Mailing Address - Phone:541-540-5274
Mailing Address - Fax:
Practice Address - Street 1:38789 KOOPMAN LN
Practice Address - Street 2:
Practice Address - City:HALFWAY
Practice Address - State:OR
Practice Address - Zip Code:97834-8113
Practice Address - Country:US
Practice Address - Phone:541-540-5274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health