MEDICARE: JACQUELYN HATLEY LVN

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	164X00000X	Licensed Vocational Nurse	1025802	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1025802	OTHER	TX	TEXAS BON

General Provider Information

NPI Number	:	1861139958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN HATLEY LVN

Provider Business Mailing Address
First Line	:	6324 OAKCREST LN
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-6967
Country	:	US
Telephone Number	:	806-223-8386
Fax Number	:

Provider Business Practice Location Address
First Line	:	6324 OAKCREST LN
Second Line	:
City	:	AMARILLO
State	:	TX
Zip	:	79109-6967
Country	:	US
Telephone Number	:	806-223-8386
Fax Number	:

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

Provider Enumeration Date	:	05/19/2022
Last Update Date	:	05/19/2022

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Directions to “ JACQUELYN HATLEY LVN” Practice Location

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