Individual
ANISSA HARGIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
301 C MIDDLETON PARK PL, LOUISVILLE, KY 40243
(502) 244-9858
(502) 244-9575
Mailing address
301 C MIDDLETON PARK PL, LOUISVILLE, KY 40243
(502) 244-9858
(502) 244-9575
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
PA353
KY
363AM0700X
Medical Physician Assistant
PA 353
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000246339
ANTHEM
KY
Enumeration date
07/11/2005
Last updated
06/11/2009
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