Provider Demographics
NPI:1265416713
Name:HESTER, PHILLIP G (PSYD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:G
Last Name:HESTER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 BARNWOOD DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2501
Mailing Address - Country:US
Mailing Address - Phone:859-331-2500
Mailing Address - Fax:859-331-2532
Practice Address - Street 1:176 BARNWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2501
Practice Address - Country:US
Practice Address - Phone:859-331-2500
Practice Address - Fax:859-331-2532
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY659103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCP00007Medicare PIN