Basic Information
Provider Information
NPI: 1659715951
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HILL
FirstName: TERRY
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential: APN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 117 S 2ND ST
Address2: PO BOX 497
City: AUGUSTA
State: AR
PostalCode: 720062309
CountryCode: US
TelephoneNumber: 8703472534
FaxNumber:  
Practice Location
Address1: 117 S 2ND ST
Address2:  
City: AUGUSTA
State: AR
PostalCode: 720062309
CountryCode: US
TelephoneNumber: 8703472534
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/18/2013
LastUpdateDate: 04/18/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XP000240ARY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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