Provider Demographics
NPI:1316928708
Name:HILL, WANDA NEWBY (DNP FNP, FPMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:NEWBY
Last Name:HILL
Suffix:
Gender:F
Credentials:DNP FNP, FPMHNP-BC
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:J
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP, FNP, FPMHNP
Mailing Address - Street 1:72A COUNTY ROAD 421
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:MS
Mailing Address - Zip Code:38873-8728
Mailing Address - Country:US
Mailing Address - Phone:662-438-7226
Mailing Address - Fax:
Practice Address - Street 1:611 ALCORN DRIVE
Practice Address - Street 2:CROSSROADS CENTER
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-9321
Practice Address - Country:US
Practice Address - Phone:662-293-4280
Practice Address - Fax:662-293-4282
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR850602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05083051Medicaid
MS05083051Medicaid
MS500002267Medicare PIN