Healthcare Provider Details

I. General information

NPI: 1568696102
Provider Name (Legal Business Name): PATRICIA CAROL HILL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SCHOOL DR
WICKES AR
71973-9312
US

IV. Provider business mailing address

130 SCHOOL DR
WICKES AR
71973-9312
US

V. Phone/Fax

Practice location:
  • Phone: 870-385-7466
  • Fax: 870-385-7700
Mailing address:
  • Phone: 870-385-7466
  • Fax: 870-385-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR10466
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: