Provider Demographics
NPI:1285362913
Name:DAVIS, HILLARY (APRN-BC)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 RED WOLF BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4585
Mailing Address - Country:US
Mailing Address - Phone:870-206-9272
Mailing Address - Fax:870-206-9274
Practice Address - Street 1:1319 RED WOLF BLVD STE C
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4585
Practice Address - Country:US
Practice Address - Phone:870-206-9272
Practice Address - Fax:870-206-9274
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR221581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221581OtherAPRN LICENSE