=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205650942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NIA VANESSA HINDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2024
-----------------------------------------------------
Last Update Date | 11/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 HEWITT DR
-----------------------------------------------------
City | WOODWAY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76712-6654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-666-7429
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 CORDELL DR
-----------------------------------------------------
City | DESOTO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75115-5478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 74933
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------