Provider Demographics
NPI:1588744890
Name:HILLMAN, HEATHER T (NP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:T
Last Name:HILLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1716 HIGHWAY 51 STE N
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-5020
Mailing Address - Country:US
Mailing Address - Phone:601-707-5621
Mailing Address - Fax:601-707-5627
Practice Address - Street 1:1716 HIGHWAY 51 STE N
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5020
Practice Address - Country:US
Practice Address - Phone:601-707-5621
Practice Address - Fax:601-707-5627
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR857290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07707774Medicaid
MS07707774Medicaid
Q30237Medicare UPIN
MS302I507631Medicare PIN