Basic Information
| Provider Information | |||||||||
| NPI: | 1588770432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATHAWAY | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 365 STOUT DRIVE BOX 70403 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376141703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234394515 | ||||||||
| FaxNumber: | 4234394060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1901 S SHADY ST | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376832021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237271150 | ||||||||
| FaxNumber: | 4237271152 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 06/24/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 92888 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0808X | 92888 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1506702 | 05 | TN | MEDICAID | 7000164 | 05 | NC | MEDICAID | TN0164 | 01 | TN | TENNCARE-JOHN DEERE | OTHER | 4309010 | 01 | TN | BCBST | OTHER | 77-8563-1 | 05 | VA | MEDICAID |