Provider Demographics
NPI:1457669087
Name:HARDY, DONITA (PA)
Entity Type:Individual
Prefix:
First Name:DONITA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 ACE DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1327
Mailing Address - Country:US
Mailing Address - Phone:859-986-3124
Mailing Address - Fax:859-986-9398
Practice Address - Street 1:1036 ACE DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1327
Practice Address - Country:US
Practice Address - Phone:859-986-3124
Practice Address - Fax:859-986-9398
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA881363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical