Provider Demographics
NPI:1194598508
Name:HACK, MORGAN D (APRN)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:D
Last Name:HACK
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7835
Mailing Address - Fax:502-350-5701
Practice Address - Street 1:4359 NEW SHEPHERDSVILLE RD UNIT 100
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8002
Practice Address - Country:US
Practice Address - Phone:502-350-5700
Practice Address - Fax:502-350-5701
Is Sole Proprietor?:No
Enumeration Date:2023-11-07
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4011677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100947170Medicaid