Kathryn P Hackney, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10004637 Issued in WA

Practice address

237 Professional Way
Shelton, WA 98584-4404

Phone

(360) 426-2500

Fax

(360) 462-2500

NPI assigned

Sep 30, 2005

Sex

Female

Sole proprietor

No

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.

• Public Hospital District No 1 of Mason County

  • Critical Access Hospital
  • Shelton, WA
  • NPI 1760568752

  WA

  Medicare reassignment NPD (past)
• Public Hospital District No 1 of Mason County

  • Clinic/Center
  • Shelton, WA
  • NPI 1306275409
  NPD
• Olympic Physicians P.L.L.C.

  • Primary Care Clinic/Center
  • Shelton, WA
  • NPI 1417156183
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in WA

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

Physician Assistant

Practice roles

Locations

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Katie N Privette Hackney Former name

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329955200000",
    "number": "1639166176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "237 PROFESSIONAL WAY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844404",
            "telephone_number": "360-426-2500",
            "fax_number": "360-462-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 PROFESSIONAL WAY",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985844404",
            "telephone_number": "360-426-2500",
            "fax_number": "360-462-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKNEY",
        "first_name": "KATHRYN",
        "middle_name": "P",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8402349",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "PRIVETTE HACKNEY",
            "middle_name": "N",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Song Yan Guo, DDS
• Deneice Gurrad, RPH
• Dean E Gushee, M.D.
• H. E. B. Behavioral Medicine, P. C.
• Hackney Family Dentistry
• Kyle Houston Hackney, DDS
• Robert Duane Hackney, DDS
• Travis S Hackney, DDS
• Dari Hagan
• Michelle Hamilton

• All providers in Shelton, WA
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2012; 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.