Provider Demographics
NPI:1437133451
Name:HACKNEY, PATRICIA A (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:HACKNEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N STURMER ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-7403
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:70 N STURMER ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-7403
Practice Address - Country:US
Practice Address - Phone:304-823-2800
Practice Address - Fax:304-823-2703
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV089367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVQ3F8696OtherMEDICARE PTAN
WV0160108000Medicaid
WV0160108000Medicaid