Provider Demographics
NPI:1487629218
Name:HILES, KATHIE (NP)
Entity Type:Individual
Prefix:
First Name:KATHIE
Middle Name:
Last Name:HILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-901-0800
Mailing Address - Fax:757-578-8547
Practice Address - Street 1:13892 TIMBER WAY
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-3332
Practice Address - Country:US
Practice Address - Phone:540-901-0800
Practice Address - Fax:757-578-8547
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024082703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487629218Medicaid
VAGC1100Medicare PIN
VA7784741OtherVA PREMIER
VA080139799OtherOPTIMA
VA007784741Medicaid
VAC05923Medicare PIN
VA500000742Medicare ID - Type Unspecified
VA080139799Medicare PIN
VAP28418Medicare UPIN