MEDICARE: KATHRYN L HACKMAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0106X	Occupational Health Registered Nurse	113135	MO
2	363LF0000X	Family Nurse Practitioner	113135	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00365026	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2578	OTHER	COX HEALTH SYSTEMS
3	250766	OTHER	HEALTHLINK
4	126814	OTHER	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760491641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN L HACKMAN FNP

Provider Business Mailing Address
First Line	:	545 BRANSON LANDING BLVD
Second Line	:	SUITE 100
City	:	BRANSON
State	:	MO
Zip	:	65616
Country	:	US
Telephone Number	:	417-335-7587
Fax Number	:	417-335-7529

Provider Business Practice Location Address
First Line	:	545 BRANSON LANDING BLVD
Second Line	:	SUITE 100
City	:	BRANSON
State	:	MO
Zip	:	65616
Country	:	US
Telephone Number	:	417-335-7587
Fax Number	:	417-335-7529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	10/29/2008

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