Provider Demographics
NPI:1972993533
Name:HINTON, MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:HINTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5103 KINOKA RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:IL
Mailing Address - Zip Code:62807-1221
Mailing Address - Country:US
Mailing Address - Phone:618-322-2243
Mailing Address - Fax:618-266-3180
Practice Address - Street 1:109 W JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2344
Practice Address - Country:US
Practice Address - Phone:618-780-9350
Practice Address - Fax:618-266-3180
Is Sole Proprietor?:No
Enumeration Date:2015-02-03
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209012523363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner