MEDICARE: VICKI LYNN HATFIELD APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	31983	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700839560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKI LYNN HATFIELD APRN

Provider Business Mailing Address
First Line	:	PO BOX 2080
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-2080
Country	:	US
Telephone Number	:	304-236-5902
Fax Number	:	304-235-4049

Provider Business Practice Location Address
First Line	:	184 E 2ND AVE STE 210
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3602
Country	:	US
Telephone Number	:	304-236-5902
Fax Number	:	304-235-4049

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	04/21/2016

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