Provider Demographics
NPI:1922755180
Name:HACKLER, GRETCHEN (APRN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:
Last Name:HACKLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ZADOCK WAY
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8215
Mailing Address - Country:US
Mailing Address - Phone:501-472-4384
Mailing Address - Fax:
Practice Address - Street 1:14 PARKSTONE CIR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7086
Practice Address - Country:US
Practice Address - Phone:501-748-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR120951363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily