Provider Demographics
NPI:1104836410
Name:HARDESTY, PEGGY (ARNP)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GILL HEART INSTITUTE 900 SOUTH LIMESTONE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0200
Mailing Address - Country:US
Mailing Address - Phone:859-323-3976
Mailing Address - Fax:859-257-6060
Practice Address - Street 1:GILL HEART INSTITUTE 800 ROSE ST
Practice Address - Street 2:G100
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0093
Practice Address - Country:US
Practice Address - Phone:859-323-0295
Practice Address - Fax:859-257-8699
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3237P363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0913904OtherKENTUCKY MEDICARE
KY78006616Medicaid
KY78006616Medicaid
KY0913904OtherKENTUCKY MEDICARE