Provider Demographics
NPI:1275882706
Name:HILL, LILY BETH (CFNP)
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:BETH
Last Name:HILL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1357
Mailing Address - Country:US
Mailing Address - Phone:304-865-3631
Mailing Address - Fax:
Practice Address - Street 1:403 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1357
Practice Address - Country:US
Practice Address - Phone:304-865-3631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV72566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550462730OtherTAX ID