Provider Demographics
NPI:1912191438
Name:HATHAWAY, SYLVIA IRENE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:IRENE
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:IRENE XANTHIS
Other - Last Name:HATHAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:AR
Mailing Address - Zip Code:72650-1060
Mailing Address - Country:US
Mailing Address - Phone:870-448-5733
Mailing Address - Fax:870-448-3767
Practice Address - Street 1:806 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-8668
Practice Address - Country:US
Practice Address - Phone:870-453-2266
Practice Address - Fax:870-453-8766
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004361363LF0000X, 363LF0000X
MO2008020651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1912191438Medicaid
AR209084758Medicaid
AR423467YQBAMedicare PIN