Amanda Eileen Hathorn, ACNPC-AG

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

226879 Issued in LA

Practice address

2400 Hospital Dr Ste 250
Bossier City, LA 71111-2390

Phone

(318) 746-4460

Fax

(318) 746-3389

NPI assigned

Aug 30, 2022

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

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• WK Bossier Surgical Associates

  • Surgery Physician
  • Bossier City, LA
  • NPI 1598234338

  LA

  Medicare reassignment NPD

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

{
    "created_epoch": "1661817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736208000000",
    "number": "1578283651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR STE 250",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112390",
            "telephone_number": "318-746-4460",
            "fax_number": "318-746-3389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HOSPITAL DR STE 250",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711112390",
            "telephone_number": "318-746-4460",
            "fax_number": "318-746-3389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHORN",
        "first_name": "AMANDA",
        "middle_name": "EILEEN",
        "credential": "ACNPC-AG",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-30",
        "last_updated": "2025-01-07",
        "certification_date": "2025-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "LA",
            "license": "226879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendy Harris
• Yekisha Harris
• Harry J Mobley MD and Willis-Knighton Medical Center
• Timothy Mark Hart, M.D.
• Timothy Mark Hart Jr., PT
• Joseph Alexander Havig, DMD
• Hawkins Transportation Services LLC
• Haygood Dental Care, LLC
• Christopher Ryan Haygood I, DDS
• Hays Homecare LLC

• Acute Care Nurse Practitioner in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Acute Care Nurse Practitioner in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.