Provider Demographics
NPI:1730776519
Name:HINDS, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:HINDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 BLAKE CIR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7191
Mailing Address - Country:US
Mailing Address - Phone:901-921-1486
Mailing Address - Fax:
Practice Address - Street 1:5025 HIGHWAY 305 N
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3602
Practice Address - Country:US
Practice Address - Phone:662-890-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS908760163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse