Provider Demographics
NPI:1932296589
Name:HINES, BRENDA PEYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:PEYTON
Last Name:HINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 DUCK CV
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-9692
Mailing Address - Country:US
Mailing Address - Phone:662-571-9001
Mailing Address - Fax:601-939-3828
Practice Address - Street 1:1006 TREETOPS BLVD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7645
Practice Address - Country:US
Practice Address - Phone:601-939-1808
Practice Address - Fax:601-939-3828
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2932084P0800X
MS102842084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05723715Medicaid