Provider Demographics
NPI:1578544409
Name:HATCHETT, MARY MOTLEY (A-GNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MOTLEY
Last Name:HATCHETT
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 DAVID TAYLOR DR STE SUITE120
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1293
Mailing Address - Country:US
Mailing Address - Phone:336-706-6614
Mailing Address - Fax:336-450-1846
Practice Address - Street 1:10926 DAVID TAYLOR DR STE 120S
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1293
Practice Address - Country:US
Practice Address - Phone:336-706-6614
Practice Address - Fax:336-450-1846
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC600053363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000151Medicaid
NC600053OtherMEDICAL BOARD
NC096526OtherNURSING
NC096526OtherNURSING
NC7000151Medicaid