Provider Demographics
NPI:1891762233
Name:HARDESTY, KEVIN (CRNA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4604 US HIGHWAY 60 W
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-6515
Mailing Address - Country:US
Mailing Address - Phone:270-389-5000
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2750
Practice Address - Country:US
Practice Address - Phone:812-547-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1085059367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74002924Medicaid
IN200295840BMedicaid
KY430070581OtherRAILROAD MEDICARE PIN
KY000000215856OtherANTHEM BCBS PIN
IN200120690CMedicaid
INCC1100FMedicare ID - Type Unspecified
KY000000215856OtherANTHEM BCBS PIN