Individual
JACOB RYAN HATHAWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4357
Mailing address
221 E MALLARD DR APT 116, BOISE, ID 83706-6603
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2025-03782
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/10/2024
Last updated
10/31/2025
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us