Healthcare Provider Details

I. General information

NPI: 1053389189
Provider Name (Legal Business Name): BEVERLY KAY HINES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 NEWTON RD
TROY OH
45373-3008
US

IV. Provider business mailing address

722 NEWTON RD
TROY OH
45373-3008
US

V. Phone/Fax

Practice location:
  • Phone: 937-339-6262
  • Fax:
Mailing address:
  • Phone: 937-339-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN180456
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN180456
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: