Healthcare Provider Details

I. General information

NPI: 1710554837
Provider Name (Legal Business Name): KAITLYN ALLISON HARDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN ALLISON BLEDSOE PA-C

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 ROY CAMPBELL DR
HAZARD KY
41701-9407
US

IV. Provider business mailing address

160 LOWER ELCOMB DR
HARLAN KY
40831-7094
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1316
  • Fax: 606-439-8457
Mailing address:
  • Phone: 606-273-4738
  • Fax: 859-817-7848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2829
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: