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: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 E HIGH ST
SPRINGFIELD OH
45505-1225
US

IV. Provider business mailing address

1821 E HIGH ST
SPRINGFIELD OH
45505-1225
US

V. Phone/Fax

Practice location:
  • Phone: 937-323-7340
  • Fax: 937-323-3363
Mailing address:
  • Phone: 937-323-7340
  • Fax: 937-323-3363

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: