Provider Demographics
NPI:1831370816
Name:HACKER, DEBORAH D (ARNP)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:D
Last Name:HACKER
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 1:525 WHITLEY ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2626
Mailing Address - Country:US
Mailing Address - Phone:606-878-7754
Mailing Address - Fax:606-864-8295
Practice Address - Street 1:525 WHITLEY ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2626
Practice Address - Country:US
Practice Address - Phone:606-878-7754
Practice Address - Fax:606-864-8295
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1879363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYS99419Medicare UPIN
KY0587903Medicare PIN