Provider Demographics
NPI:1477705507
Name:HILL, CONNIE H (RNP)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:H
Last Name:HILL
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E OAK AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4163
Mailing Address - Country:US
Mailing Address - Phone:870-935-6729
Mailing Address - Fax:870-268-4408
Practice Address - Street 1:201 E OAK AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4163
Practice Address - Country:US
Practice Address - Phone:870-935-6729
Practice Address - Fax:870-268-4408
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP00765174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP00765OtherNURSING LICENSE
ARP00765OtherNURSING LICENSE
P85212Medicare UPIN