Provider Demographics
NPI:1750113312
Name:HATHORN, CALLIE ANN (FNP-BC, ACNPC-AG)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANN
Last Name:HATHORN
Suffix:
Gender:F
Credentials:FNP-BC, ACNPC-AG
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:ANN
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:239 MARBLE PL
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-2201
Mailing Address - Country:US
Mailing Address - Phone:601-660-5935
Mailing Address - Fax:
Practice Address - Street 1:4481 VIKING DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7414
Practice Address - Country:US
Practice Address - Phone:318-626-2593
Practice Address - Fax:318-399-7717
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA236634363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care