Basic Information
| Provider Information | |||||||||
| NPI: | 1265708002 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HINTON | ||||||||
| FirstName: | CANDANCE | ||||||||
| MiddleName: | REBECCA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6051 U S HIGHWAY 49 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394017200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012882690 | ||||||||
| FaxNumber: | 6012882695 | ||||||||
| Practice Location | |||||||||
| Address1: | 6051 U S HIGHWAY 49 | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394017200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012882690 | ||||||||
| FaxNumber: | 6012882695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 01/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R856290 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 9139899 | 01 | MS | AETNA | OTHER | 302I500748 | 01 | MS | MEDICARE PTAN | OTHER | P01087213 | 01 | MS | RAILROAD MEDICARE | OTHER | 03087004 | 05 | MS | MEDICAID |