Provider Demographics
NPI:1437718384
Name:HATLEY, HA THUY (MD)
Entity Type:Individual
Prefix:DR
First Name:HA
Middle Name:THUY
Last Name:HATLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 ANDERSON HEALTHCARE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-7784
Mailing Address - Country:US
Mailing Address - Phone:618-288-8500
Mailing Address - Fax:
Practice Address - Street 1:3417 ANDERSON HEALTHCARE DR STE 200
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-7784
Practice Address - Country:US
Practice Address - Phone:618-288-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021004767207P00000X
MO2019018922207Q00000X
IL036.158962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty