=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275333577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTIE K HATINGER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2025
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 S 3RD AVE
-----------------------------------------------------
City | BIG RAPIDS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49307-9501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-796-5825
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3405 S CEDAR RD
-----------------------------------------------------
City | CHASE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49623-8600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-878-3377
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------