Provider Demographics
NPI:1366478588
Name:FRESCOLN, HILARY A (MD)
Entity Type:Individual
Prefix:MRS
First Name:HILARY
Middle Name:A
Last Name:FRESCOLN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:HILARY
Other - Middle Name:A
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 505164
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5164
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:
Practice Address - Street 1:104 EAST HWY 60
Practice Address - Street 2:
Practice Address - City:MT VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-0000
Practice Address - Country:US
Practice Address - Phone:417-934-2251
Practice Address - Fax:417-934-2871
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011017815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP01106286OtherRR MCR
MO431560263OtherTRICARE
MO1366478588Medicaid
MO431560263OtherTRICARE