Gary James Hackett, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA1110 Issued in KY

Practice address

2845 Chancellor Dr
Crestview Hills, KY 41017-3418

Phone

(859) 426-4200

Fax

(859) 426-4206

NPI assigned

Apr 29, 2008

Last updated

Jan 21, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390262400000",
    "number": "1003081258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 S LOOP RD",
            "city": "EDGEWOOD",
            "state": "KY",
            "postal_code": "410173405",
            "telephone_number": "859-301-2663",
            "fax_number": "859-301-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 CHANCELLOR DR",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173418",
            "telephone_number": "859-426-4200",
            "fax_number": "859-426-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKETT",
        "first_name": "GARY",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2014-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA1110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100050170",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB8861",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard W Grover, MD
• Christine R. Grubbs, COTA
• Paul R Guenthner, M.D.
• Susan S. Gurley, DPT
• Anne Wallace Haag, LCSW
• Janet Dea Hackett
• Russell Hall
• Michael S Halpin, M.D.
• Samantha Jo Handorf, RBT
• Hanger Prosthetics & Orthotics East Inc (Hanger Clinic)

• Surgical Physician Assistant in Crestview Hills, KY
• Providers in Crestview Hills, KY by specialty
• Surgical Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.