Provider Demographics
NPI:1801537758
Name:HATFIELD, TARA DAWN (APRN,FNP-C,FNP-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DAWN
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:APRN,FNP-C,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-7026
Mailing Address - Country:US
Mailing Address - Phone:304-239-8070
Mailing Address - Fax:
Practice Address - Street 1:1690 HOLDEN RD
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-7026
Practice Address - Country:US
Practice Address - Phone:304-239-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV112490363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner