Provider Demographics
NPI:1558394395
Name:HATLER, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HATLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3173 KIRBY WHITTEN RD
Mailing Address - Street 2:STE 104
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2881
Mailing Address - Country:US
Mailing Address - Phone:901-384-8040
Mailing Address - Fax:
Practice Address - Street 1:1660 BONNIE LN
Practice Address - Street 2:SUITE 105
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0518
Practice Address - Country:US
Practice Address - Phone:901-888-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11654363LP0808X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Not Answered163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice