Provider Demographics
NPI:1225310998
Name:LEE, HILLARY JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:JANE
Last Name:LEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HILLARY
Other - Middle Name:J
Other - Last Name:BLEDSOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2200 FOREST RIDGE PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-2943
Practice Address - Country:US
Practice Address - Phone:765-599-3400
Practice Address - Fax:765-599-3426
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001327A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000799703OtherANTHEM BCBS PIN
INP01214966Medicare PIN
INM400057073Medicare PIN
IN264430030Medicare PIN