Provider Demographics
NPI:1548238306
Name:HESCOCK, HAROLD ROBERT JR (PA)
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:ROBERT
Last Name:HESCOCK
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 SUITE B
Mailing Address - Street 2:BRUCE PROFESSIONAL OFFICE PARK
Mailing Address - City:MT. STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353
Mailing Address - Country:US
Mailing Address - Phone:859-498-1460
Mailing Address - Fax:859-498-5862
Practice Address - Street 1:101 SUITE B
Practice Address - Street 2:BRUCE PROFESSIONAL OFFICE PARK
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9772
Practice Address - Country:US
Practice Address - Phone:859-498-1460
Practice Address - Fax:859-498-5862
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95003927Medicaid
KY0634503Medicare PIN
KYK007050Medicare PIN
KYP93869Medicare UPIN
KY95003927Medicaid