Healthcare Provider Details

I. General information

NPI: 1720444615
Provider Name (Legal Business Name): JACQUI LYNN HILL APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 UNDERCLIFF TER INAS ALATTAR - PEDIATRICS
PRINCETON WV
24740-2175
US

IV. Provider business mailing address

143 UNDERCLIFF TERRACE INAS ALATTAR- PEDIATRICS
PRINCETON WV
24740
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-0415
  • Fax:
Mailing address:
  • Phone: 304-487-0415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number60105
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: