Provider Demographics
NPI:1073523122
Name:HATCH, LINDA (FNP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 SW COLUMBIA ST
Mailing Address - Street 2:STE 6210
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1099
Mailing Address - Country:US
Mailing Address - Phone:541-383-3005
Mailing Address - Fax:
Practice Address - Street 1:375 NW BEAVER ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1802
Practice Address - Country:US
Practice Address - Phone:541-447-0707
Practice Address - Fax:541-447-0708
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006723N1-FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH682402OtherPACIFIC SOURCE HEALTH PLA
ORH682410OtherPACIFIC SOURCE HEALTH PLA
OR804845001OtherBLUE CROSS BLUE SHIELD
OR182960Medicaid
S29006Medicare UPIN
OR182960Medicaid