Jeremy Scott Hataway, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

670631 Issued in TX

Practice address

4560 Lake Ridge Pkwy Ste 110
Grand Prairie, TX 75052-1707

Phone

(972) 522-7778

Fax

(972) 522-7779

NPI assigned

Dec 11, 2008

Last updated

Oct 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency Physician Associates of North Carolina, P.C.

  • Emergency Medicine Physician
  • Jacksonville, NC
  • NPI 1306887609
  NPD (past)

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

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1528203155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 LAKE RIDGE PKWY STE 110",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750521707",
            "telephone_number": "972-522-7778",
            "fax_number": "972-522-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 LAKE RIDGE PKWY STE 110",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750521707",
            "telephone_number": "972-522-7778",
            "fax_number": "972-522-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATAWAY",
        "first_name": "JEREMY",
        "middle_name": "SCOTT",
        "credential": "FNP-BC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-12-11",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004212",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "670631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP LICENSE",
            "identifier": "670631",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Hart
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• Health Is Wealth,LLC
• Healthcare Equipment Services LLC
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• Family Nurse Practitioner in Grand Prairie, TX
• Providers in Grand Prairie, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.