Healthcare Provider Details

I. General information

NPI: 1942605142
Provider Name (Legal Business Name): MELISSA B HINDS APRN, NNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 09/25/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4481 ASH GROVE DR STE B
SPRINGFIELD IL
62711-6359
US

IV. Provider business mailing address

4481 ASH GROVE DR STE B
SPRINGFIELD IL
62711-6359
US

V. Phone/Fax

Practice location:
  • Phone: 217-803-7341
  • Fax:
Mailing address:
  • Phone: 217-803-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209-011875
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209011875
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: