Provider Demographics
NPI:1649755133
Name:MAYBERRY, HILLARY MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:MICHELLE
Last Name:MAYBERRY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HILLARY
Other - Middle Name:MICHELLE
Other - Last Name:HANVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6249 HEART STONE DR
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-7048
Mailing Address - Country:US
Mailing Address - Phone:501-551-1849
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
ARPA-811363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical