Provider Demographics
NPI:1831172170
Name:HILL, TAMMY JO (APRN)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JO
Last Name:HILL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:92 JOE T PETTY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELL SPRINGS
Mailing Address - State:KY
Mailing Address - Zip Code:42642
Mailing Address - Country:US
Mailing Address - Phone:270-858-3429
Mailing Address - Fax:270-858-3350
Practice Address - Street 1:92 JOE T PETTY DRIVE
Practice Address - Street 2:
Practice Address - City:RUSSELL SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42642
Practice Address - Country:US
Practice Address - Phone:270-858-3429
Practice Address - Fax:270-858-3350
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003543363LA2200X
KY3543P363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78006350Medicaid
KYP40906Medicare UPIN
KY78006350Medicaid