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General NPI Number Information
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NPI Number | 1770962961
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Entity Type | Individual
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Provider Name | JUDY HACKER APRN
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Gender | Female
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Dates
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Enumeration Date | 05/21/2015
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Last Update Date | 06/02/2015
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Provider Practice Location Address
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Address Line | 94 MARIE LANGDON DR SUITE 4
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City | MANCHESTER
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State | KY
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Zip | 40962-6353
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Country | US
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Telephone | 606-598-7900
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Fax | 606-598-1040
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Provider Business Mailing Address
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Address Line | 509 MEMORIAL DR SUITE 2
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City | MANCHESTER
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State | KY
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Zip | 40962-6195
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Country | US
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Telephone | 606-598-5104
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Fax | 606-598-0983
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3009354
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License Number State | KY
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