Provider Demographics
NPI:1376800250
Name:HILAND, CHANIN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CHANIN
Middle Name:
Last Name:HILAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EDDYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42038-7386
Mailing Address - Country:US
Mailing Address - Phone:270-388-5454
Mailing Address - Fax:270-388-5452
Practice Address - Street 1:627 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EDDYVILLE
Practice Address - State:KY
Practice Address - Zip Code:42038-7386
Practice Address - Country:US
Practice Address - Phone:270-388-5454
Practice Address - Fax:270-388-5452
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003618363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100446330Medicaid