Provider Demographics
NPI:1649443797
Name:HINES, PATRICIA CROSS
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:CROSS
Last Name:HINES
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 1:5524 LIBERTY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-4262
Mailing Address - Country:US
Mailing Address - Phone:901-757-2541
Mailing Address - Fax:
Practice Address - Street 1:5524 LIBERTY RIDGE CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-4262
Practice Address - Country:US
Practice Address - Phone:901-757-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSM3219282N00000X
TNCSW1164282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital