Basic Information
Provider Information
NPI: 1104275916
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KIEFFER
FirstName: HILARY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 844658
Address2:  
City: DALLAS
State: TX
PostalCode: 752844658
CountryCode: US
TelephoneNumber: 2547242111
FaxNumber:  
Practice Location
Address1: 706 AVENUE G
Address2:  
City: MARBLE FALLS
State: TX
PostalCode: 786545866
CountryCode: US
TelephoneNumber: 8302018900
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2016
LastUpdateDate: 01/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XR4728TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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