| Doctor Name: | GARY JAMES HACKETT |
| NPI Number: | 1003081258 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA1110 |
| Business Practice Address: | 2845 Chancellor Dr Crestview Hills, KY - 410173418 |
| Business Phone Number: | 8594264200 |
| Business Fax Number: | 8594264206 |
| Mailing Address: | 560 S Loop Rd, EDGEWOOD |
| State: | KY |
| Postal Code: | 410173405 |
| Phone Number: | 8593012663 |
| Fax Number: | 8593010655 |
| NPI Enumeration Date: | 04/29/2008 |
| NPI Last Update Date: | 01/21/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA1110 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |