Provider Demographics
NPI:1194336891
Name:HATHCOCK, KRISTEN (PHD, NREMT)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:HATHCOCK
Suffix:
Gender:F
Credentials:PHD, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 SE 50 RD
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-9268
Mailing Address - Country:US
Mailing Address - Phone:620-450-6275
Mailing Address - Fax:
Practice Address - Street 1:1450 SE 50 RD
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-9268
Practice Address - Country:US
Practice Address - Phone:620-450-6275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53003146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO72667OtherBEMS
E3181012OtherNREMT
KS53003OtherKBEMS