Healthcare Provider Details

I. General information

NPI: 1275334823
Provider Name (Legal Business Name): GAVRIELLE MARIE HINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 US 60
VAN BUREN MO
63965
US

IV. Provider business mailing address

1011 US 60
VAN BUREN MO
63965
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-2171
  • Fax:
Mailing address:
  • Phone: 573-323-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2019034310
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: