Provider Demographics
NPI:1437301090
Name:HATCH, JENNIFER LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:HATCH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-5708
Mailing Address - Country:US
Mailing Address - Phone:864-512-1417
Mailing Address - Fax:864-512-1823
Practice Address - Street 1:800 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-5708
Practice Address - Country:US
Practice Address - Phone:864-512-1340
Practice Address - Fax:864-512-1749
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC214443367500000X
PARN331800L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNPI # & SSN#OtherBLUE CHOICE
SC30103723OtherFIRST CHOICE-SELECT HEALTH
SCNPI # / SSN#OtherTRICARE
SCAN2161Medicaid
GA003114855AMedicaid
PA039832OtherMEDICARE GROUP
SCNPI # & SSN#OtherBLUE CROSS
SCNPI # & SSN#OtherBLUE CHOICE
SCNPI # / SSN#OtherTRICARE
PR142216N8ZMedicare PIN