Provider Demographics
NPI:1699549006
Name:KELLY, HILLARY MARIA (IBCLC)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:MARIA
Last Name:KELLY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15909 PIN HOOK AVE
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-6670
Mailing Address - Country:US
Mailing Address - Phone:217-671-9635
Mailing Address - Fax:
Practice Address - Street 1:15909 PIN HOOK AVE
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-6670
Practice Address - Country:US
Practice Address - Phone:217-671-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-311402174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN