Healthcare Provider Details

I. General information

NPI: 1336058502
Provider Name (Legal Business Name): MELISSA HARDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 MAIN ST CABIN
CHALLIS ID
83278
US

IV. Provider business mailing address

PO BOX 1408
CHALLIS ID
83226-1408
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-8146
  • Fax:
Mailing address:
  • Phone: 208-365-8146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6081430
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: