Healthcare Provider Details

I. General information

NPI: 1669567137
Provider Name (Legal Business Name): JENNIFER LYNN HARDIN P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 FLEMINGSBURG RD
MOREHEAD KY
40351-1015
US

IV. Provider business mailing address

405 CLINIC DR
MOREHEAD KY
40351-1077
US

V. Phone/Fax

Practice location:
  • Phone: 606-780-5500
  • Fax: 606-783-7281
Mailing address:
  • Phone: 606-780-5500
  • Fax: 606-783-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA412
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA412
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: