Healthcare Provider Details

I. General information

NPI: 1316928708
Provider Name (Legal Business Name): WANDA NEWBY HILL DNP FNP, FPMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WANDA J. HILL RN, NP, FNP, FPMHNP

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ALCORN DRIVE CROSSROADS CENTER
CORINTH MS
38834-9321
US

IV. Provider business mailing address

72A COUNTY ROAD 421
TISHOMINGO MS
38873-8728
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-4280
  • Fax: 662-293-4282
Mailing address:
  • Phone: 662-438-7226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR850602
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: