MEDICARE: MS. KATHRYN DELENE HINES REGISTERED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	5183	OH

General Provider Information

NPI Number	:	1700019759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN DELENE HINES REGISTERED DIETITIAN

Provider Business Mailing Address
First Line	:	100 MEDICAL CENTER DR
Second Line	:	SPRINGFIELD REGIONAL MEDICAL CENTER, NUTRITION SERVICES
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2687
Country	:	US
Telephone Number	:	937-523-5415
Fax Number	:

Provider Business Practice Location Address
First Line	:	1343 NORTH FOUNTAIN BLVD.
Second Line	:	SPRINGFIELD REGIONAL MEDICAL CENTER, NUTRITION SERVICES
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-1499
Country	:	US
Telephone Number	:	937-390-5510
Fax Number	:	937-390-5358

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	01/25/2016

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