MEDICARE: AMANDA HARDY CRNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1-136075	AL

General Provider Information

NPI Number	:	1174051643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA HARDY CRNP

Provider Business Mailing Address
First Line	:	16546 HIGHWAY 280
Second Line	:
City	:	DADEVILLE
State	:	AL
Zip	:	36853-2528
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 AIRPORT DR
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3436
Country	:	US
Telephone Number	:	256-212-9300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	05/30/2017

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