Provider Demographics
NPI:1669193801
Name:HINES-BEARD, JESSICA BROOKE (OD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROOKE
Last Name:HINES-BEARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37206-1659
Mailing Address - Country:US
Mailing Address - Phone:901-857-0511
Mailing Address - Fax:
Practice Address - Street 1:1227 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3531
Practice Address - Country:US
Practice Address - Phone:931-388-3604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist