Provider Demographics
NPI:1811635923
Name:HART, KATIE ELLEN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ELLEN
Last Name:HART
Suffix:
Gender:
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112B HIGH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4052
Mailing Address - Country:US
Mailing Address - Phone:270-589-0929
Mailing Address - Fax:
Practice Address - Street 1:1070 SMITH GROVE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42164-9444
Practice Address - Country:US
Practice Address - Phone:270-239-6024
Practice Address - Fax:270-239-6099
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3017750207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3017750OtherKBN