Healthcare Provider Details

I. General information

NPI: 1548643802
Provider Name (Legal Business Name): VALERIE G HILDEBRAND NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4814 LAKELAND DR
FLOWOOD MS
39232-8694
US

IV. Provider business mailing address

4814 LAKELAND DR
FLOWOOD MS
39232-8694
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-6401
  • Fax: 601-326-6405
Mailing address:
  • Phone: 601-948-6540
  • Fax: 601-326-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number869656
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number869656
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number869656
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: