Healthcare Provider Details

I. General information

NPI: 1922957836
Provider Name (Legal Business Name): TIMOTHY WAYNE HATCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 W 800 S
CEDAR CITY UT
84720-1202
US

IV. Provider business mailing address

1401 E STAGECOACH LN
ENOCH UT
84721-7436
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-2899
  • Fax:
Mailing address:
  • Phone: 435-586-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11013664-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number11013664-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: