Provider Demographics
NPI:1578748810
Name:HILLIS, KATHY MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:MARIE
Last Name:HILLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:KATHY
Other - Middle Name:MARIE
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:240 NEW BYHALIA RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3716
Mailing Address - Country:US
Mailing Address - Phone:901-492-4920
Mailing Address - Fax:901-492-4921
Practice Address - Street 1:240 NEW BYHALIA RD
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3716
Practice Address - Country:US
Practice Address - Phone:901-492-4920
Practice Address - Fax:901-492-4921
Is Sole Proprietor?:No
Enumeration Date:2008-01-06
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012762363L00000X
TN12762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner