Provider Demographics
NPI:1003390436
Name:HEARN, GERRY
Entity Type:Individual
Prefix:
First Name:GERRY
Middle Name:
Last Name:HEARN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:WILLISBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40078-0188
Mailing Address - Country:US
Mailing Address - Phone:859-375-9200
Mailing Address - Fax:859-375-9202
Practice Address - Street 1:2084 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISBURG
Practice Address - State:KY
Practice Address - Zip Code:40078-8199
Practice Address - Country:US
Practice Address - Phone:859-375-9200
Practice Address - Fax:859-375-9202
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical