Provider Demographics
NPI:1306460290
Name:HARDSOCK, KACIANNA (PA-C)
Entity type:Individual
Prefix:
First Name:KACIANNA
Middle Name:
Last Name:HARDSOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KACI
Other - Middle Name:
Other - Last Name:HARDSOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:372 BLACK GAP RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17222-9734
Mailing Address - Country:US
Mailing Address - Phone:717-496-5582
Mailing Address - Fax:
Practice Address - Street 1:6780 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2203
Practice Address - Country:US
Practice Address - Phone:440-312-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007720363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical