Provider Demographics
NPI:1427372788
Name:HILL, JESSICA R (RN, MSN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:R
Last Name:HILL
Suffix:
Gender:F
Credentials:RN, MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MEDICAL PARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1100
Mailing Address - Country:US
Mailing Address - Phone:276-378-3020
Mailing Address - Fax:276-378-3025
Practice Address - Street 1:245 MEDICAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-1100
Practice Address - Country:US
Practice Address - Phone:276-378-3020
Practice Address - Fax:276-378-3025
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001184404163WX0200X
VA0024168699363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517506Medicaid
VA1427372788Medicaid
VA0024168699OtherVIRGINIA NURSE PRACTITIONER LICENSE
TN1517506Medicaid
VAVV2498AMedicare PIN