Provider Demographics
NPI:1023998184
Name:HATHORN, JOHN CADE (RN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CADE
Last Name:HATHORN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-9681
Mailing Address - Country:US
Mailing Address - Phone:601-408-0295
Mailing Address - Fax:
Practice Address - Street 1:15 PARADISE LN
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-9681
Practice Address - Country:US
Practice Address - Phone:601-408-0295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS912205163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice