Healthcare Provider Details

I. General information

NPI: 1801528559
Provider Name (Legal Business Name): JESSICA M HINES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST STE 3100
DAYTON OH
45409-2722
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-4110
  • Fax: 937-208-6260
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN.CNP.0030009
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: