MEDICARE: MRS. STACY MENDENHALL HILL NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	5004351	NC
2	363L00000X	Nurse Practitioner	5004351	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306088380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY MENDENHALL HILL NP-C

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-992-8181
Fax Number	:	336-996-9539

Provider Business Practice Location Address
First Line	:	12208 N NC HIGHWAY 150
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-9730
Country	:	US
Telephone Number	:	336-764-2324
Fax Number	:	336-764-9541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	10/28/2020

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Directions to “ MRS. STACY MENDENHALL HILL NP-C” Practice Location

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