Healthcare Provider Details

I. General information

NPI: 1558956466
Provider Name (Legal Business Name): KATY JANE HILL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATY JANE LUNCEFORD PA

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E DAWSON ST
TYLER TX
75701-2036
US

IV. Provider business mailing address

1000 DOVE CREEK DR
ATHENS TX
75751-2950
US

V. Phone/Fax

Practice location:
  • Phone: 903-606-7264
  • Fax:
Mailing address:
  • Phone: 903-681-7885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: