Basic Information
| Provider Information | |||||||||
| NPI: | 1710960729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HATCHER | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAVELKA | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1137 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
| FaxNumber: | 4172559732 | ||||||||
| Practice Location | |||||||||
| Address1: | 1137 INDEPENDENCE DR | ||||||||
| Address2: | |||||||||
| City: | WEST PLAINS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 657754221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4172558464 | ||||||||
| FaxNumber: | 4172559732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2009014869 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1710960729 | 05 | MO | MEDICAID |