Healthcare Provider Details

I. General information

NPI: 1619794054
Provider Name (Legal Business Name): MELISSA RENA HILL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 CHESTNUT ST
MONTGOMERY AL
36106-1111
US

IV. Provider business mailing address

578 HOLLOW WOOD RD
MONTGOMERY AL
36109-3337
US

V. Phone/Fax

Practice location:
  • Phone: 334-269-0212
  • Fax:
Mailing address:
  • Phone: 334-652-8990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024026281
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: