Provider Demographics
NPI:1053389189
Name:HINES, BEVERLY KAY (RN)
Entity type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:KAY
Last Name:HINES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 NEWTON RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3008
Mailing Address - Country:US
Mailing Address - Phone:937-339-6262
Mailing Address - Fax:
Practice Address - Street 1:722 NEWTON RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3008
Practice Address - Country:US
Practice Address - Phone:937-339-6262
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN180456163W00000X, 163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development