Provider Demographics
NPI:1619099918
Name:HATCHER, KIMBERLY DENISE (APRN-BC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DENISE
Last Name:HATCHER
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DENISE
Other - Last Name:FERRY, WRAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8824
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8824
Mailing Address - Country:US
Mailing Address - Phone:706-320-3770
Mailing Address - Fax:706-320-3772
Practice Address - Street 1:2000 16TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1665
Practice Address - Country:US
Practice Address - Phone:706-320-3770
Practice Address - Fax:706-320-3772
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2015-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154558163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003140075BMedicaid
GANCO-000003OtherNURSE PRACTITIONER
GA2013005222OtherPMHCNS-BC
AL164957Medicaid
GARN154558OtherRN LICENSE
GA003140075BMedicaid