Provider Demographics
NPI:1366467300
Name:HILL, SHIRLENE BROOKS (DO)
Entity Type:Individual
Prefix:
First Name:SHIRLENE
Middle Name:BROOKS
Last Name:HILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 LOUIS SESSIONS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71653-6150
Mailing Address - Country:US
Mailing Address - Phone:870-265-3813
Mailing Address - Fax:870-265-3219
Practice Address - Street 1:2819 LOUIS SESSIONS ST
Practice Address - Street 2:
Practice Address - City:LAKE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71653-6150
Practice Address - Country:US
Practice Address - Phone:870-265-3813
Practice Address - Fax:870-265-3219
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-8382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARF36346Medicare UPIN
AR5J222Medicare ID - Type Unspecified