Healthcare Provider Details

I. General information

NPI: 1508874736
Provider Name (Legal Business Name): KATHLEEN E HAYCRAFT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 MEDICAL DR
HANNIBAL MO
63401-6884
US

IV. Provider business mailing address

163 MEDICAL DR
HANNIBAL MO
63401-6884
US

V. Phone/Fax

Practice location:
  • Phone: 573-248-3900
  • Fax:
Mailing address:
  • Phone: 573-719-1818
  • Fax: 573-719-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number072208
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: