Provider Demographics
NPI:1508950502
Name:HILL, KATHY (NP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HILL
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 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4749
Mailing Address - Fax:
Practice Address - Street 1:610 SECOND ST
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145-3135
Practice Address - Country:US
Practice Address - Phone:601-854-5044
Practice Address - Fax:601-854-8448
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR668281363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0121654Medicaid
MS753068151OtherMHP
MS753068151OtherMPCN
753068151006OtherTRICARE
MS0121654Medicaid
MS753068151OtherMPCN