1669567137 NPI number — JENNIFER LYNN HARDIN P.A.-C.

Table of content: JENNIFER LYNN HARDIN P.A.-C. (NPI 1669567137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669567137 NPI number — JENNIFER LYNN HARDIN P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDIN
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669567137
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 CLINIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOREHEAD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40351-1077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-780-5500
Provider Business Mailing Address Fax Number:
606-783-7281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 FLEMINGSBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOREHEAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40351-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-780-5500
Provider Business Practice Location Address Fax Number:
606-783-7281
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA412 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA412 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: K032922 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 95000386 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37903705 . This is a "MEDICAID LAB GRP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4000501 . This is a "MEDICARE LAB GRP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: CB5773 . This is a "RR MEDICARE GRP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: P00190999 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com