Healthcare Provider Details

I. General information

NPI: 1932296589
Provider Name (Legal Business Name): BRENDA PEYTON HINES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TREETOPS BLVD
FLOWOOD MS
39232-7606
US

IV. Provider business mailing address

1001 TREETOPS BLVD
FLOWOOD MS
39232-7606
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-1808
  • Fax: 601-939-3828
Mailing address:
  • Phone: 601-939-1808
  • Fax: 601-939-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number10284
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number10284
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number10284
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: