Provider Demographics
NPI:1922573963
Name:HATLEY, AMY MARIE (APRN/FNP/BC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:HATLEY
Suffix:
Gender:F
Credentials:APRN/FNP/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 GOLDSMITH RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-9509
Mailing Address - Country:US
Mailing Address - Phone:870-236-7782
Mailing Address - Fax:870-239-6329
Practice Address - Street 1:801 GOLDSMITH RD
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-9509
Practice Address - Country:US
Practice Address - Phone:870-236-7782
Practice Address - Fax:870-239-6329
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005304363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily