Individual
BREN HINES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
210 E GRAY ST STE 900, LOUISVILLE, KY 40202-3905
(502) 584-7525
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
363A00000X
Physician Assistant
Primary
TC877
KY
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA12298
TEXAS MEDICAL BOARD
TX
01
—
TC877
KY LICENSE
KY
Enumeration date
10/24/2018
Last updated
10/19/2020
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