Healthcare Provider Details

I. General information

NPI: 1003268467
Provider Name (Legal Business Name): ANNA KELLY HARDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SOUTH LIMESTONE
LEXINGTON KY
40536-7356
US

IV. Provider business mailing address

1010 MAIN ST S
MC KEE KY
40447-7089
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-2778
  • Fax:
Mailing address:
  • Phone: 859-626-7700
  • Fax: 859-626-7890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3010580
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: