Provider Demographics
NPI:1407448988
Name:HATLEY, PHILLIP CRAIG (APRN, CNP)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:CRAIG
Last Name:HATLEY
Suffix:
Gender:
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 HIDDEN PATH
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5576
Mailing Address - Country:US
Mailing Address - Phone:580-504-5467
Mailing Address - Fax:
Practice Address - Street 1:908 N ROCKFORD RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-2540
Practice Address - Country:US
Practice Address - Phone:580-223-0447
Practice Address - Fax:580-223-2989
Is Sole Proprietor?:No
Enumeration Date:2021-02-06
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK200220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily