Provider Demographics
NPI:1629275011
Name:HATCHER, BEVERLY A (RNFA)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:A
Last Name:HATCHER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 SCOTTSVILLE RD STE B2 PMB 137
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-5836
Mailing Address - Country:US
Mailing Address - Phone:270-782-0434
Mailing Address - Fax:270-782-0564
Practice Address - Street 1:1725 ASHLEY CIR STE 211
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-5820
Practice Address - Country:US
Practice Address - Phone:270-782-0434
Practice Address - Fax:270-782-0564
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1051150363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical