Individual provider Active NPI

Katinna Evette Hines, RPH

  • Pharmacist
  • Concord, NC
National Provider Identifier
1720340268
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
17489 Issued in NC
Practice address
1245 Concord Pkwy N
Concord, NC 28025-4325
Phone
(704) 795-9868
Fax
(704) 788-3805
NPI assigned
Jun 11, 2012
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X RPH019859 GA
Pharmacist 183500000X PS31866 FL
Pharmacist 183500000X 17489 NC Primary

Addresses

Primary practice location

1245 Concord Pkwy N
Concord, NC 28025-4325

Mailing address

1245 Concord Pkwy N
Concord, NC 28025-4325
Phone (704) 795-9868

Other identifiers 3

IdentifierTypeStateIssuer
3432729OtherNABP
56-1390087OtherFEDERAL TAX ID
0135723MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
PS31866FLMDPharmacist
RPH019859GAMDPharmacist
17489NCMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Harris Teeter LLC Past Accepting new patients
Harris Teeter, LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1720340268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1245 CONCORD PKWY N",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280254325",
            "telephone_number": "704-795-9868",
            "fax_number": "704-788-3805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 CONCORD PKWY N",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280254325",
            "telephone_number": "704-795-9868",
            "fax_number": "704-788-3805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINES",
        "first_name": "KATINNA",
        "middle_name": "EVETTE",
        "credential": "RPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-11",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "GA",
            "license": "RPH019859",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS31866",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NC",
            "license": "17489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP",
            "identifier": "3432729",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "56-1390087",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0135723",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.