Provider Demographics
NPI:1821023920
Name:HATCHER, JEFFRY CLARK (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:CLARK
Last Name:HATCHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-8117
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:402-553-5092
Practice Address - Street 1:21022 ROCKY KNOLL SQ APT 105
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5715
Practice Address - Country:US
Practice Address - Phone:571-442-4674
Practice Address - Fax:402-800-7635
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280380OtherMEDICARE PTAN
NE280380OtherMEDICARE PTAN