Provider Demographics
NPI:1629097522
Name:GANT, HILLARY LAINE (CRNP)
Entity Type:Individual
Prefix:
First Name:HILLARY
Middle Name:LAINE
Last Name:GANT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2171 COUNTY ROAD 68
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-3905
Mailing Address - Country:US
Mailing Address - Phone:205-270-0603
Mailing Address - Fax:
Practice Address - Street 1:110 23RD ST NW
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1001
Practice Address - Country:US
Practice Address - Phone:205-932-3891
Practice Address - Fax:205-932-3996
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-084725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51003763OtherBCBS
AL051557383Medicaid
AL051557383Medicaid
AL051557383HANMedicare ID - Type Unspecified