Provider Demographics
NPI:1376013714
Name:HILL, ERIN RENEE (AGACNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RENEE
Last Name:HILL
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RENEE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 GRANDE OAKS ESTS
Mailing Address - Street 2:
Mailing Address - City:PELAHATCHIE
Mailing Address - State:MS
Mailing Address - Zip Code:39145-3388
Mailing Address - Country:US
Mailing Address - Phone:601-259-0773
Mailing Address - Fax:
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-815-1318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902142363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty