Provider Demographics
NPI:1003944679
Name:HASTEY, KATHRIN G (FNPC)
Entity Type:Individual
Prefix:
First Name:KATHRIN
Middle Name:G
Last Name:HASTEY
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:KATHRIN
Other - Middle Name:G
Other - Last Name:ROCKNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-404-8200
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:6 TELCOM DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3072
Practice Address - Country:US
Practice Address - Phone:207-947-0147
Practice Address - Fax:207-990-3365
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81364363LF0000X
MEAP081364363LF0000X
MER045019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME307940099Medicaid
NP489902Medicare PIN
P93422Medicare UPIN
ME307940099Medicaid