Provider Demographics
NPI:1164250486
Name:HARDY, KURT KUSAKABE (PA-C)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:KUSAKABE
Last Name:HARDY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13625 ACADIA PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4403
Mailing Address - Country:US
Mailing Address - Phone:317-478-7778
Mailing Address - Fax:
Practice Address - Street 1:3985 PRINCE WILLIAM PKWY STE 102
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7900
Practice Address - Country:US
Practice Address - Phone:703-590-8375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant