Provider Demographics
NPI:1225887847
Name:HILL, KELLY MARIE (APRN, MSN, FNP-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:HILL
Suffix:
Gender:F
Credentials:APRN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1553 CENTRAL TRAILS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6372
Mailing Address - Country:US
Mailing Address - Phone:901-277-0788
Mailing Address - Fax:
Practice Address - Street 1:1250 FARROW RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7116
Practice Address - Country:US
Practice Address - Phone:901-332-7290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSF05240363363LF0000X
MSR887939363LF0000X
TN36521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily