Healthcare Provider Details

I. General information

NPI: 1912567066
Provider Name (Legal Business Name): VIVIAN RENEE HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BISHOP ST
CORBIN KY
40701-1702
US

IV. Provider business mailing address

1019 CUMBERLAND FALLS HWY STE B201
CORBIN KY
40701-2793
US

V. Phone/Fax

Practice location:
  • Phone: 606-528-2124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3013449
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: