Provider Demographics
NPI:1700019759
Name:HINES, KATHRYN DELENE (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:DELENE
Last Name:HINES
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:SPRINGFIELD REGIONAL MEDICAL CENTER, NUTRITION SERVICES
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-2687
Mailing Address - Country:US
Mailing Address - Phone:937-523-5415
Mailing Address - Fax:
Practice Address - Street 1:1343 NORTH FOUNTAIN BLVD.
Practice Address - Street 2:SPRINGFIELD REGIONAL MEDICAL CENTER, NUTRITION SERVICES
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1499
Practice Address - Country:US
Practice Address - Phone:937-390-5510
Practice Address - Fax:937-390-5358
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5183133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered