Provider Demographics
NPI:1215288782
Name:HARDESTY, ANNA R (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:R
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:R
Other - Last Name:O'COYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-788-6993
Mailing Address - Fax:360-788-6995
Practice Address - Street 1:2901 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1851
Practice Address - Country:US
Practice Address - Phone:360-788-6993
Practice Address - Fax:360-788-6995
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60313294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215288782Medicaid
WA0299769OtherL&I AND CRIME VICTIMS
WA1215288782OtherTRI-WEST (TRICARE)
WA1215288782OtherREGENCE BLUE SHIELD