Healthcare Provider Details

I. General information

NPI: 1861178840
Provider Name (Legal Business Name): ANDREA MICHELLE HATFIELD AA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA MICHELLE FOUCHIA

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068
US

IV. Provider business mailing address

1531 NW 67TH TER
KANSAS CITY MO
64118
US

V. Phone/Fax

Practice location:
  • Phone: 816-352-7555
  • Fax:
Mailing address:
  • Phone: 816-352-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number2023030684
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: