Provider Demographics
NPI:1558993741
Name:HINES SMITH, KOURTNI ANNAE (MD)
Entity Type:Individual
Prefix:
First Name:KOURTNI
Middle Name:ANNAE
Last Name:HINES SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CHEW ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3434
Mailing Address - Country:US
Mailing Address - Phone:610-776-4888
Mailing Address - Fax:833-690-3863
Practice Address - Street 1:450 CHEW ST STE 101
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3434
Practice Address - Country:US
Practice Address - Phone:610-776-4888
Practice Address - Fax:833-690-3863
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD482445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program