Provider Demographics
NPI:1407513369
Name:HILLIARD, JADE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 GETTYSBURG RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2520
Mailing Address - Country:US
Mailing Address - Phone:614-442-1012
Mailing Address - Fax:614-442-7726
Practice Address - Street 1:4900 GETTYSBURG RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2520
Practice Address - Country:US
Practice Address - Phone:614-442-1012
Practice Address - Fax:614-442-7726
Is Sole Proprietor?:No
Enumeration Date:2021-11-26
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007868RX363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty