1619099918 NPI number — MRS. KIMBERLY DENISE HATCHER APRN-BC

Table of content: MRS. KIMBERLY DENISE HATCHER APRN-BC (NPI 1619099918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619099918 NPI number — MRS. KIMBERLY DENISE HATCHER APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATCHER
Provider First Name:
KIMBERLY
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRY, WRAGG
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619099918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8824
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31908-8824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-320-3770
Provider Business Mailing Address Fax Number:
706-320-3772

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 16TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31901-1665
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-320-3770
Provider Business Practice Location Address Fax Number:
706-320-3772
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WP0808X , with the licence number:  RN154558 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: RN154558 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003140075B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: NCO-000003 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2013005222 . This is a "PMHCNS-BC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 164957 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: RN154558 . This is a "RN LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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