Provider Demographics
NPI:1558956466
Name:HILL, KATY JANE (PA)
Entity Type:Individual
Prefix:
First Name:KATY
Middle Name:JANE
Last Name:HILL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:JANE
Other - Last Name:LUNCEFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1000 DOVE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2950
Mailing Address - Country:US
Mailing Address - Phone:903-681-7885
Mailing Address - Fax:
Practice Address - Street 1:800 E DAWSON ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2036
Practice Address - Country:US
Practice Address - Phone:903-606-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1N3122OtherMEDICARE
TX1N1452OtherMEDICARE