Provider Demographics
NPI:1174519540
Name:HATFIELD, PATRICK LEE (CRNA)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:LEE
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 20TH ST
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41014-1583
Mailing Address - Country:US
Mailing Address - Phone:859-655-7160
Mailing Address - Fax:859-655-6742
Practice Address - Street 1:85 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-572-3232
Practice Address - Fax:859-572-3727
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7075607367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2441352Medicaid
KY74003344Medicaid
611077369006 4022322OtherHEALTHNET
IN200956850Medicaid
P400034286Medicare PIN
KY0969478Medicare PIN
OH2441352Medicaid