Provider Demographics
NPI:1538332366
Name:HIPP, BILLY WAYNE (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:WAYNE
Last Name:HIPP
Suffix:
Gender:M
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17200 CHENAL PKWY STE 300-323
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5958
Mailing Address - Country:US
Mailing Address - Phone:312-402-4477
Mailing Address - Fax:
Practice Address - Street 1:17200 CHENAL PKWY STE 300-323
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223-5958
Practice Address - Country:US
Practice Address - Phone:312-402-4477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-13
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005082363LA2200X
IL209.0007022363LA2200X
CT4672363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
ILP00632735 RAILROADMedicare PIN
ILK51471Medicare PIN
ILK51472Medicare PIN