Healthcare Provider Details

I. General information

NPI: 1265436224
Provider Name (Legal Business Name): CHERRI DENISE HATFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 52 MAIN ST
GILBERT WV
25621-1675
US

IV. Provider business mailing address

184 E 2ND AVE STE 1
WILLIAMSON WV
25661-3602
US

V. Phone/Fax

Practice location:
  • Phone: 304-664-8924
  • Fax: 304-664-8746
Mailing address:
  • Phone: 304-664-8924
  • Fax: 304-664-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number962
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: