Provider Demographics
NPI:1548643802
Name:HILDEBRAND, VALERIE G (NP)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:G
Last Name:HILDEBRAND
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 1:4814 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8694
Mailing Address - Country:US
Mailing Address - Phone:601-948-6540
Mailing Address - Fax:601-326-6405
Practice Address - Street 1:4814 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8694
Practice Address - Country:US
Practice Address - Phone:601-326-6401
Practice Address - Fax:601-326-6405
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS869656363LA2200X, 363LX0001X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00322571Medicaid