=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477452480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEVAEH ANN HACKATHORN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3712 SW BURLINGAME RD
-----------------------------------------------------
City | TOPEKA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66609-1201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-366-0724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6416 50TH ST
-----------------------------------------------------
City | MERIDEN
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66512-9277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | RBT-26-2852749
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------