Provider Demographics
NPI:1467928267
Name:HINES, MELISSA ANDREA
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:ANDREA
Last Name:HINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5369 PIPERS GAP DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38134-6409
Mailing Address - Country:US
Mailing Address - Phone:901-567-0450
Mailing Address - Fax:
Practice Address - Street 1:5369 PIPERS GAP DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38134-6409
Practice Address - Country:US
Practice Address - Phone:901-567-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN82-0696563Medicaid