Provider Demographics
NPI:1982153946
Name:HATHAWAY, ROBIN (RN)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:BINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1401 SW 8TH TER
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2516
Mailing Address - Country:US
Mailing Address - Phone:913-231-7105
Mailing Address - Fax:816-347-3046
Practice Address - Street 1:901 NE INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5544
Practice Address - Country:US
Practice Address - Phone:816-581-5852
Practice Address - Fax:816-347-3046
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO054062163W00000X
MO163W0000X163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208480319Medicaid
MO208480319Medicaid