Healthcare Provider Details

I. General information

NPI: 1578954533
Provider Name (Legal Business Name): JENNIFER HARDY CASELLA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER HARDY NP

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 15TH ST
AUGUSTA GA
30901-2608
US

IV. Provider business mailing address

950 15TH ST
AUGUSTA GA
30901-2608
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-823-3983
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-823-3983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN183834
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN183834
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN183834
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN183834
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: