Provider Demographics
NPI:1144953787
Name:HARDYMON, HANNAH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:HARDYMON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:MAYSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 FARRIS RD
Mailing Address - Street 2:
Mailing Address - City:FLEMINGSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41041-8668
Mailing Address - Country:US
Mailing Address - Phone:606-495-7100
Mailing Address - Fax:
Practice Address - Street 1:333 BEACON HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-6182
Practice Address - Country:US
Practice Address - Phone:606-784-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY245290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered