Individual provider · NPI-1

Derron Terrell Hines

Technician, Attendant Care Provider · Florissant, MO

NPI number1871477042
StatusActive
Last updated in NPPESAug 1, 2025

Details

NPI
1871477042
Entity type
Individual (NPI-1)
Name
Derron Terrell Hines
Sex
Male
Sole proprietor
No
Enumeration date
Aug 1, 2025
Certification date
Aug 1, 2025
Last updated
Aug 1, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
3747A0650X Technician, Attendant Care Provider3747a0650xMOYes

Practice location

12464 Partridge Run Dr
Florissant, MO 63033-5008

Phone 314-637-6649

Mailing address

12464 Partridge Run Dr
Florissant, MO 63033-5008

Phone 314-637-6649

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