Provider Demographics
NPI:1740446988
Name:HINESLY, NANCY ELLEN (APRN, CNM, IBCLC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:ELLEN
Last Name:HINESLY
Suffix:
Gender:F
Credentials:APRN, CNM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-6560
Mailing Address - Country:US
Mailing Address - Phone:615-944-7630
Mailing Address - Fax:
Practice Address - Street 1:7040 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37221-6560
Practice Address - Country:US
Practice Address - Phone:615-944-7630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011426176B00000X
TNL-61007163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7100057180Medicaid