Healthcare Provider Details

I. General information

NPI: 1902803117
Provider Name (Legal Business Name): JAMES ALLEN HEDRICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 5TH ST
BARDSTOWN KY
40004-1142
US

IV. Provider business mailing address

201 S 5TH ST
BARDSTOWN KY
40004-1142
US

V. Phone/Fax

Practice location:
  • Phone: 502-348-6309
  • Fax: 502-348-2793
Mailing address:
  • Phone: 502-348-6309
  • Fax: 502-348-2793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17943
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: