Healthcare Provider Details

I. General information

NPI: 1619099918
Provider Name (Legal Business Name): KIMBERLY DENISE HATCHER APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY DENISE FERRY, WRAGG

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 16TH AVE
COLUMBUS GA
31901-1665
US

IV. Provider business mailing address

PO BOX 8824
COLUMBUS GA
31908-8824
US

V. Phone/Fax

Practice location:
  • Phone: 706-320-3770
  • Fax: 706-320-3772
Mailing address:
  • Phone: 706-320-3770
  • Fax: 706-320-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN154558
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN154558
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: