Provider Demographics
NPI:1861830689
Name:HINES, CHRISTYL JADE (CRNP)
Entity Type:Individual
Prefix:
First Name:CHRISTYL
Middle Name:JADE
Last Name:HINES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CHRISTYL
Other - Middle Name:JADE
Other - Last Name:LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-1216
Mailing Address - Country:US
Mailing Address - Phone:334-427-3034
Mailing Address - Fax:334-427-3949
Practice Address - Street 1:848 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5320
Practice Address - Country:US
Practice Address - Phone:334-427-3034
Practice Address - Fax:334-427-3949
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-124873363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily