Individual
GARY JAMES HACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2845 CHANCELLOR DR, CRESTVIEW HILLS, KY 41017-3418
(859) 426-4200
(859) 426-4206
Mailing address
560 S LOOP RD, EDGEWOOD, KY 41017-3405
(859) 301-2663
(859) 301-0655
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA1110
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100050170
—
KY
01
—
CB8861
RAILROAD MEDICARE
KY
Enumeration date
04/29/2008
Last updated
01/21/2014
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