Healthcare Provider Details

I. General information

NPI: 1508301797
Provider Name (Legal Business Name): DIWANETRA HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2016
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 N RAILROAD AVE
ARCADIA LA
71001-3423
US

IV. Provider business mailing address

116 HEARD RD
RUSTON LA
71270-1033
US

V. Phone/Fax

Practice location:
  • Phone: 318-579-5105
  • Fax: 318-579-5106
Mailing address:
  • Phone: 318-278-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number151812
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: