Provider Demographics
NPI:1669785465
Name:BETHEL-HINES, CYNETHIA LASHONDA MAE (APRN)
Entity type:Individual
Prefix:MRS
First Name:CYNETHIA
Middle Name:LASHONDA MAE
Last Name:BETHEL-HINES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:CYNETHIA
Other - Middle Name:LASHONDA MAE
Other - Last Name:BETHEL-JAITEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:234 AMY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40212-2522
Mailing Address - Country:US
Mailing Address - Phone:502-778-0001
Mailing Address - Fax:
Practice Address - Street 1:234 AMY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40212-2522
Practice Address - Country:US
Practice Address - Phone:502-778-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006459363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100130310Medicaid