=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710554837
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAITLYN ALLISON HARDY PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2021
-----------------------------------------------------
Last Update Date | 01/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 181 ROY CAMPBELL DR
-----------------------------------------------------
City | HAZARD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41701-9407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-439-1316
-----------------------------------------------------
Fax | 606-439-8457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 LOWER ELCOMB DR
-----------------------------------------------------
City | HARLAN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40831-7094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-273-4738
-----------------------------------------------------
Fax | 859-817-7848
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA2829
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------