Healthcare Provider Details

I. General information

NPI: 1972582104
Provider Name (Legal Business Name): PATRICK K HYNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 US HIGHWAY 42
PROSPECT KY
40059-8858
US

IV. Provider business mailing address

PO BOX 950293
LOUISVILLE KY
40295-0293
US

V. Phone/Fax

Practice location:
  • Phone: 502-228-1312
  • Fax: 502-228-5541
Mailing address:
  • Phone: 888-987-1875
  • Fax: 405-609-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number32278
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: