Provider Demographics
NPI:1700386398
Name:VANDIVER, HILARY A (APRN)
Entity Type:Individual
Prefix:
First Name:HILARY
Middle Name:A
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:2025 W EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367-5401
Practice Address - Country:US
Practice Address - Phone:270-377-2600
Practice Address - Fax:270-377-2610
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3011960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300012535Medicaid
KY7100509330Medicaid