Provider Demographics
NPI:1740752450
Name:HARDESTY, ELYSE MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:MARIE
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 1:700 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2604
Mailing Address - Country:US
Mailing Address - Phone:270-351-3192
Mailing Address - Fax:270-351-5499
Practice Address - Street 1:700 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2604
Practice Address - Country:US
Practice Address - Phone:270-351-3192
Practice Address - Fax:270-351-5499
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner