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General NPI Number Information
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NPI Number | 1457669087
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Entity Type | Individual
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Provider Name | DONITA HARDY PA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 05/18/2012
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Provider Practice Location Address
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Address Line | 1036 ACE DR
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City | BEREA
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State | KY
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Zip | 40403-1327
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Country | US
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Telephone | 859-986-3124
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Fax | 859-986-9398
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Provider Business Mailing Address
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Address Line | 1036 ACE DR
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City | BEREA
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State | KY
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Zip | 40403-1327
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Country | US
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Telephone | 859-986-3124
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Fax | 859-986-9398
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA881
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License Number State | KY
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