Basic Information
| Provider Information | |||||||||
| NPI: | 1831706779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HATLEY | ||||||||
| FirstName: | NEKOL | ||||||||
| MiddleName: | ANTOINETTE | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 CREEKWOOD DR | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751463403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2148750111 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1016 TACOMA AVE | ||||||||
| Address2: | |||||||||
| City: | SUNNYSIDE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989442263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098371500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2020 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 747757 | TX | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.