Provider Demographics
NPI:1942516117
Name:HINTON-OMERE, JESSIE FAYE
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:FAYE
Last Name:HINTON-OMERE
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 1:1101 WENDELL WAY
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1722
Mailing Address - Country:US
Mailing Address - Phone:972-926-3873
Mailing Address - Fax:972-240-2931
Practice Address - Street 1:1101 WENDELL WAY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1722
Practice Address - Country:US
Practice Address - Phone:972-926-3873
Practice Address - Fax:972-240-2931
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTAXOther171M00000X