Provider Demographics
NPI:1457891806
Name:HILL, BOBBY JR (APN-BC RN PHRN BOF)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:
Last Name:HILL
Suffix:JR
Gender:M
Credentials:APN-BC RN PHRN BOF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 N COUNTRY FAIR DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2485
Mailing Address - Country:US
Mailing Address - Phone:176-028-6272
Mailing Address - Fax:
Practice Address - Street 1:606 N COUNTRY FAIR DR STE A
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-2485
Practice Address - Country:US
Practice Address - Phone:217-602-8627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209016021363L00000X
IN71008122A363L00000X
IL277000188363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner