Provider Demographics
NPI:1376565515
Name:HINES-DOWELL, STACY JA'NET (DNP, APNG, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JA'NET
Last Name:HINES-DOWELL
Suffix:
Gender:F
Credentials:DNP, APNG, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7384 WOODSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2752
Mailing Address - Country:US
Mailing Address - Phone:901-483-5791
Mailing Address - Fax:
Practice Address - Street 1:7384 WOODSHIRE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2752
Practice Address - Country:US
Practice Address - Phone:901-483-5791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN128760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily