Basic Information
Provider Information
NPI: 1437230927
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAYDEN
FirstName: ROBERT
MiddleName: AARON
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 636961
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452636961
CountryCode: US
TelephoneNumber: 8886963541
FaxNumber:  
Practice Location
Address1: 1532 LONE OAK RD
Address2: SUITE 143
City: PADUCAH
State: KY
PostalCode: 420037913
CountryCode: US
TelephoneNumber: 2705386600
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/18/2006
LastUpdateDate: 09/15/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AM0700XTC513KYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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