Provider Demographics
NPI:1386877413
Name:HINES, CARRIE (NP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:HINES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47471-1524
Mailing Address - Country:US
Mailing Address - Phone:812-227-0382
Mailing Address - Fax:812-585-6097
Practice Address - Street 1:4444 W STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-9691
Practice Address - Country:US
Practice Address - Phone:812-876-2915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28137521A363LF0000X
IN71003027A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily