Provider Demographics
NPI:1467408138
Name:HATCH, LAURA (PA-C)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:HATCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-7347
Mailing Address - Country:US
Mailing Address - Phone:402-366-2185
Mailing Address - Fax:
Practice Address - Street 1:3907 6TH AVE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3392
Practice Address - Country:US
Practice Address - Phone:308-865-2767
Practice Address - Fax:308-865-2765
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1177363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1177OtherSTATE LICENSE NUMBER
38944OtherBCBS
NE47077294513Medicaid
NE278631LHMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NE47077294513Medicaid
P00453181Medicare PIN
38944OtherBCBS