Provider Demographics
NPI:1740496330
Name:HINDS, HANNELORE AUDREY MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:HANNELORE
Middle Name:AUDREY MARIA
Last Name:HINDS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 N HENNY RD
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-6127
Mailing Address - Country:US
Mailing Address - Phone:405-255-1336
Mailing Address - Fax:
Practice Address - Street 1:7450 N HENNY RD
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-6127
Practice Address - Country:US
Practice Address - Phone:405-255-1336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1642363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant