Active NPI
Deryl Phillip Hilliard, ED.D.
- Psychologist
- Jackson, TN
National Provider Identifier
1407926322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- P0000001755
- Practice address
- 367 B N. Parkway
Suite 1
Jackson, TN 38305 - Phone
- (731) 668-2277
- Fax
- (731) 660-0510
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | P0000001755 | TN | Primary |
Addresses
Primary practice location
367 B N. Parkway
Suite 1
Jackson, TN 38305
Mailing address
55 Meadows Access
Henderson, TN 38340-3623
Phone (731) 989-9112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P0000001755 | TN | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gayle M Cravens | Past | Accepting new patients | |
| David Pickering | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Jackson, TN
- NPI 1851569412
-
- Mental Health Counselor
- Jackson, TN
- NPI 1972702223
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407926322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 MEADOWS ACCESS",
"city": "HENDERSON",
"state": "TN",
"postal_code": "383403623",
"telephone_number": "731-989-9112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "367 B N. PARKWAY",
"address_2": "SUITE 1",
"city": "JACKSON",
"state": "TN",
"postal_code": "38305",
"telephone_number": "731-668-2277",
"fax_number": "731-660-0510"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HILLIARD",
"first_name": "DERYL",
"middle_name": "PHILLIP",
"name_prefix": "Dr.",
"credential": "ED.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "TN",
"license": "P0000001755",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.