Healthcare Provider Details

I. General information

NPI: 1043176308
Provider Name (Legal Business Name): DESTINY MICHELE HINES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DESTINY MICHELE TRIVETT

II. Dates (important events)

Enumeration Date: 12/30/2025
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 W FORK RD
CINCINNATI OH
45247-7548
US

IV. Provider business mailing address

3747 W FORK RD
CINCINNATI OH
45247-7548
US

V. Phone/Fax

Practice location:
  • Phone: 513-481-4777
  • Fax:
Mailing address:
  • Phone: 513-481-4777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number479740
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: