Healthcare Provider Details

I. General information

NPI: 1437956307
Provider Name (Legal Business Name): JENNIFER CHANA HINES MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 PORTSMOUTH DR
RICHARDSON TX
75082-4838
US

IV. Provider business mailing address

2106 PORTSMOUTH DR
RICHARDSON TX
75082-4838
US

V. Phone/Fax

Practice location:
  • Phone: 919-986-2092
  • Fax:
Mailing address:
  • Phone: 919-986-2092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number48383567
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: