Provider Demographics
NPI:1770899387
Name:HATCH, JUDITH WALDINE (APRN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:WALDINE
Last Name:HATCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4966
Mailing Address - Fax:502-458-5751
Practice Address - Street 1:1 TRILLIUM WAY
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8727
Practice Address - Country:US
Practice Address - Phone:606-523-8779
Practice Address - Fax:606-523-8721
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004847363LP0808X
KY3008397363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100273870Medicaid
NC7004560Medicaid
KYP01458976OtherRR MEDICARE
KY7100273870Medicaid