Provider Demographics
NPI:1356183974
Name:HILLIS, MILDRED MARIE
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:MARIE
Last Name:HILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6020 YUCCA TRL
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-8240
Mailing Address - Country:US
Mailing Address - Phone:361-944-6733
Mailing Address - Fax:
Practice Address - Street 1:6020 YUCCA TRL
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-8240
Practice Address - Country:US
Practice Address - Phone:361-944-6733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-12
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168899164W00000X
TX1169501363LF0000X
TX706128163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse