Provider Demographics
NPI:1053702126
Name:HARDESTY, KENT (CRNA)
Entity type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 CHARDON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-1016
Mailing Address - Country:US
Mailing Address - Phone:440-725-7406
Mailing Address - Fax:
Practice Address - Street 1:131 CHARDON AVE
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-1016
Practice Address - Country:US
Practice Address - Phone:440-725-7406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-11
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.345500-COA1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered