Provider Demographics
NPI:1851676969
Name:HILTON-PRILLHART, ANGELA NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:NICOLE
Last Name:HILTON-PRILLHART
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NICOLE
Other - Last Name:MOUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:2020 MEADOWVIEW PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-7388
Mailing Address - Country:US
Mailing Address - Phone:423-398-5719
Mailing Address - Fax:
Practice Address - Street 1:2020 MEADOWVIEW PARKWAY, SUITE 3
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1103
Practice Address - Country:US
Practice Address - Phone:423-398-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3053103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004400Medicaid