Provider Demographics
NPI:1093808636
Name:HYMAN, MILDRED M (FNP & PTA)
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:M
Last Name:HYMAN
Suffix:
Gender:F
Credentials:FNP & PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-6282
Mailing Address - Fax:828-687-6285
Practice Address - Street 1:132 HOMESTEAD FARM CIRCLE
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-8208
Practice Address - Country:US
Practice Address - Phone:828-687-8670
Practice Address - Fax:828-687-6293
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24225200000X
NC0050-02729363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00710078OtherMEDICARE RAILROAD
NC2593564Medicare PIN