Provider Demographics
NPI:1407448988
Name:HATLEY, PHILLIP CRAIG (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CRAIG
Last Name:HATLEY
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 COMANCHE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1730
Mailing Address - Country:US
Mailing Address - Phone:580-504-5467
Mailing Address - Fax:
Practice Address - Street 1:200 W BRITTON RD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-3626
Practice Address - Country:US
Practice Address - Phone:405-755-8000
Practice Address - Fax:405-755-8001
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily