Provider Demographics
NPI:1871477042
Name:HINES, DERRON TERRELL
Entity type:Individual
Prefix:
First Name:DERRON
Middle Name:TERRELL
Last Name:HINES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12464 PARTRIDGE RUN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5008
Mailing Address - Country:US
Mailing Address - Phone:314-637-6649
Mailing Address - Fax:
Practice Address - Street 1:12464 PARTRIDGE RUN DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5008
Practice Address - Country:US
Practice Address - Phone:314-637-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3747A0650X3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider