Provider Demographics
NPI:1396329769
Name:HILLBILLY HEALTHCARE LLC
Entity type:Organization
Organization Name:HILLBILLY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTORATE NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DNP-C
Authorized Official - Phone:304-433-2229
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:KEARNEYSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25430-0726
Mailing Address - Country:US
Mailing Address - Phone:304-433-2229
Mailing Address - Fax:304-724-7399
Practice Address - Street 1:12 QUASAR DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-7706
Practice Address - Country:US
Practice Address - Phone:304-839-3454
Practice Address - Fax:304-724-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568626174OtherNPI
WV1568626174OtherNPI NUMBER FOR INDIVIDUAL TO BE LINKED TO THIS ACCOUNT