Provider Demographics
NPI:1144861386
Name:HINDS, MICHAELLA RENAE (NP-C)
Entity type:Individual
Prefix:MISS
First Name:MICHAELLA
Middle Name:RENAE
Last Name:HINDS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 RESERVE RD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-0133
Mailing Address - Country:US
Mailing Address - Phone:515-554-9277
Mailing Address - Fax:
Practice Address - Street 1:7808 CLODUS FIELDS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251-2206
Practice Address - Country:US
Practice Address - Phone:972-770-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF09191736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily