Provider Demographics
NPI:1326025339
Name:HILLS, KIMBERLY D (PA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:HILLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-8949
Mailing Address - Country:US
Mailing Address - Phone:330-674-1200
Mailing Address - Fax:330-674-3320
Practice Address - Street 1:151 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8949
Practice Address - Country:US
Practice Address - Phone:330-674-1200
Practice Address - Fax:330-674-3320
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2305OtherLICENSE
OHHIPA25581Medicare ID - Type UnspecifiedMEDICARE ID
OHQ52845Medicare UPIN