Provider Demographics
NPI:1396375952
Name:HARTLEY, KEVIN THOMAS
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:THOMAS
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-2010
Mailing Address - Country:US
Mailing Address - Phone:859-282-2024
Mailing Address - Fax:859-282-6747
Practice Address - Street 1:7000 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-2010
Practice Address - Country:US
Practice Address - Phone:859-282-2024
Practice Address - Fax:859-282-6747
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014140207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine