Healthcare Provider Details

I. General information

NPI: 1154247831
Provider Name (Legal Business Name): KIRSTEN COLLETTE HATLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 CLEMMONS RD
CLEMMONS NC
27012-8479
US

IV. Provider business mailing address

3851 DUNHAGAN RD STE 102
GREENVILLE NC
27858-6640
US

V. Phone/Fax

Practice location:
  • Phone: 252-751-0518
  • Fax: 252-565-4505
Mailing address:
  • Phone: 252-751-0518
  • Fax: 252-565-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: