Provider Demographics
NPI:1598471401
Name:KORN, HILARY JEANINE
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:JEANINE
Last Name:KORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437
Mailing Address - Country:US
Mailing Address - Phone:707-961-6208
Mailing Address - Fax:707-200-6682
Practice Address - Street 1:516 CYPRESS ST
Practice Address - Street 2:FORT BRAGG
Practice Address - City:CALIFORNIA
Practice Address - State:CA
Practice Address - Zip Code:95437
Practice Address - Country:US
Practice Address - Phone:707-961-6208
Practice Address - Fax:707-200-6682
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA172V0000X172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator