Provider Demographics
NPI:1578044277
Name:TILLEY-HICKS, ALIANNE S (APRN)
Entity type:Individual
Prefix:
First Name:ALIANNE
Middle Name:S
Last Name:TILLEY-HICKS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ALIANNE
Other - Middle Name:SPENCER
Other - Last Name:TILLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-1080
Mailing Address - Country:US
Mailing Address - Phone:270-858-6655
Mailing Address - Fax:270-858-4027
Practice Address - Street 1:333 BOGLE ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2873
Practice Address - Country:US
Practice Address - Phone:606-678-0705
Practice Address - Fax:606-678-2807
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY14314122OtherCAQH
KY7100552970Medicaid