Provider Demographics
NPI:1184760571
Name:HINTON, WENDY WALKER (BS, MAOM)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:WALKER
Last Name:HINTON
Suffix:
Gender:F
Credentials:BS, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2359 COVINGTON CREEK CIR E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1173
Mailing Address - Country:US
Mailing Address - Phone:904-221-3822
Mailing Address - Fax:
Practice Address - Street 1:1100 CESERY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-5699
Practice Address - Country:US
Practice Address - Phone:904-745-3070
Practice Address - Fax:904-745-3087
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator