Healthcare Provider Details

I. General information

NPI: 1710742721
Provider Name (Legal Business Name): MICHAEL HATFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 BISHOP LN
ELIZABETHTOWN KY
42701-9266
US

IV. Provider business mailing address

202 BISHOP LN
ELIZABETHTOWN KY
42701-9266
US

V. Phone/Fax

Practice location:
  • Phone: 270-234-0003
  • Fax: 270-360-0840
Mailing address:
  • Phone: 270-234-0003
  • Fax: 270-360-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: