Basic Information
| Provider Information | |||||||||
| NPI: | 1760491641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HACKMAN | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357587 | ||||||||
| FaxNumber: | 4173357529 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 BRANSON LANDING BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRANSON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173357587 | ||||||||
| FaxNumber: | 4173357529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 10/29/2008 | ||||||||
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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 | 163WX0106X | 113135 | MO | N | Nursing Service Providers | Registered Nurse | Occupational Health | 363LF0000X | 113135 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2578 | 01 | COX HEALTH SYSTEMS | OTHER | P00365026 | 01 | RAILROAD MEDICARE | OTHER | 250766 | 01 | HEALTHLINK | OTHER | 126814 | 01 | BCBS | OTHER | 428135354 | 05 | MO | MEDICAID | 209396704 | 05 | MO | MEDICAID |