Healthcare Provider Details

I. General information

NPI: 1912191438
Provider Name (Legal Business Name): SYLVIA IRENE HATHAWAY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYLVIA IRENE XANTHIS HATHAWAY

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 E MAIN ST
FLIPPIN AR
72634-8668
US

IV. Provider business mailing address

PO BOX 1060
MARSHALL AR
72650-1060
US

V. Phone/Fax

Practice location:
  • Phone: 870-453-2266
  • Fax: 870-453-8766
Mailing address:
  • Phone: 870-448-5733
  • Fax: 870-448-3767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004361
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: