Provider Demographics
NPI:1447824404
Name:HATHAWAY, JASON (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SW 45TH AVE STE T
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-5676
Mailing Address - Country:US
Mailing Address - Phone:806-355-3000
Mailing Address - Fax:
Practice Address - Street 1:3501 SW 45TH AVE STE T
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-5676
Practice Address - Country:US
Practice Address - Phone:806-355-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily