Active NPI
Laura Lorraine Hackworth, APRN,CNP
- Nurse Practitioner
- Swansea, IL
National Provider Identifier
1295849032
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 209006150
- Practice address
- 510 Fullerton Rd
Swansea, IL 62226-2970 - Phone
- (618) 233-7666
- Fax
- (618) 233-7461
- NPI assigned
- Aug 18, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 209006150 | IL | Primary |
Addresses
Primary practice location
510 Fullerton Rd
Swansea, IL 62226-2970
Mailing address
510 Fullerton Rd
Swansea, IL 62226-2970
Phone (618) 233-7666
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209006150 | Medicaid | IL | |
| P00372772 | Other | IL | MEDICARE RR PTAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Distinctive Dermatologyltd | Nurse Practitioner | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1286928000000",
"number": "1295849032",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 FULLERTON RD",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262970",
"telephone_number": "618-233-7666",
"fax_number": "618-233-7461"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 FULLERTON RD",
"city": "SWANSEA",
"state": "IL",
"postal_code": "622262970",
"telephone_number": "618-233-7666",
"fax_number": "618-233-7461"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKWORTH",
"first_name": "LAURA",
"middle_name": "LORRAINE",
"credential": "APRN,CNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-18",
"last_updated": "2010-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IL",
"license": "209006150",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "209006150",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR PTAN",
"identifier": "P00372772",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Swansea, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.