Healthcare Provider Details

I. General information

NPI: 1427685775
Provider Name (Legal Business Name): ANTWONETTE HILLIARD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date: 01/19/2026
Reactivation Date: 02/24/2026

III. Provider practice location address

1120 DEPOT LN SE STE 100
CEDAR RAPIDS IA
52401-2547
US

IV. Provider business mailing address

8816 MANCHESTER RD # 296
BRENTWOOD MO
63144-2602
US

V. Phone/Fax

Practice location:
  • Phone: 888-329-6613
  • Fax: 385-900-1659
Mailing address:
  • Phone: 888-329-6613
  • Fax: 385-900-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG190032
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2011018337
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number202601257
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberG190032
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: