Vicki Helene Hathorn, NP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R703869 Issued in MS

Practice address

1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116

Phone

(601) 362-4471

Fax

(601) 364-1305

NPI assigned

Nov 1, 2006

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1205913886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1039",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390601039",
            "telephone_number": "601-832-7096",
            "fax_number": "601-364-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165116",
            "telephone_number": "601-362-4471",
            "fax_number": "601-364-1305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHORN",
        "first_name": "VICKI",
        "middle_name": "HELENE",
        "name_prefix": "Miss",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MS",
            "license": "R703869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Y Hastings, LCSW
• Marnisha Hatch
• Arlin George Hatfield III, MD
• Mary Hathorn, MS
• Stephanie Anne Hathorn
• Karl Hatten, M.D.
• Margaret Thurber Hatten, M.D.
• Hattiesburg Road Dental, P.C. (Kool Smiles)
• Hattiesburg Road Dental, P.C. (Sunnybrook Dentistry)
• Logan Sears Havard, MD

• Adult Health Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Adult Health Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.