Individual
MICHAEL D HARDESTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(208) 367-8855
(208) 954-8073
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-283
ID
363AS0400X
Surgical Physician Assistant
C04084
MD
363AS0400X
Surgical Physician Assistant
Primary
PA-903
ID
Other
Enumeration date
03/01/2007
Last updated
12/02/2025
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