Provider Demographics
NPI:1790666550
Name:HATHAWAY, DAVID HUNTER
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:HUNTER
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2414
Mailing Address - Country:US
Mailing Address - Phone:740-701-4663
Mailing Address - Fax:
Practice Address - Street 1:6 E 68TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2414
Practice Address - Country:US
Practice Address - Phone:740-701-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD.09706133V00000X
MO2024007234133V00000X
86277927133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered