Healthcare Provider Details

I. General information

NPI: 1023688264
Provider Name (Legal Business Name): LACY R HILL APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 KANIS RD STE 101
LITTLE ROCK AR
72205-6358
US

IV. Provider business mailing address

11001 EXECUTIVE CENTER DR STE 200
LITTLE ROCK AR
72211-4393
US

V. Phone/Fax

Practice location:
  • Phone: 501-202-1902
  • Fax: 501-202-1512
Mailing address:
  • Phone: 501-812-7215
  • Fax: 501-812-7207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number215004
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: