Provider Demographics
NPI:1265708002
Name:HINTON, CANDANCE REBECCA (FNP)
Entity type:Individual
Prefix:
First Name:CANDANCE
Middle Name:REBECCA
Last Name:HINTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 U S HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7200
Mailing Address - Country:US
Mailing Address - Phone:601-288-2690
Mailing Address - Fax:601-288-2695
Practice Address - Street 1:6051 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7200
Practice Address - Country:US
Practice Address - Phone:601-288-2690
Practice Address - Fax:601-288-2695
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR856290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9139899OtherAETNA
MS302I500748OtherMEDICARE PTAN
MSP01087213OtherRAILROAD MEDICARE
MS03087004Medicaid