Provider Demographics
NPI:1598499303
Name:HATFIELD, FAYEDRA STARR (RN)
Entity Type:Individual
Prefix:
First Name:FAYEDRA
Middle Name:STARR
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SAN MADINA CT
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1564
Mailing Address - Country:US
Mailing Address - Phone:281-658-3188
Mailing Address - Fax:
Practice Address - Street 1:622 SAN MADINA CT
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1564
Practice Address - Country:US
Practice Address - Phone:281-658-3188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-16
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX906885163WE0003X
TX1089271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency