Provider Demographics
NPI:1942503834
Name:HILLIARD, WANDA (PMHNP-BC,APN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:PMHNP-BC,APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9813 MEMORIAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-4274
Mailing Address - Country:US
Mailing Address - Phone:281-913-3550
Mailing Address - Fax:
Practice Address - Street 1:30 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151-3008
Practice Address - Country:US
Practice Address - Phone:540-483-0582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX703524363LP0808X
TXAP119602363LP0808X
VA0024178774363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health