Healthcare Provider Details

I. General information

NPI: 1487166310
Provider Name (Legal Business Name): JAMES KADEN HARDING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 N ALPINE RD
ROCKFORD IL
61107-2201
US

IV. Provider business mailing address

1253 N ALPINE RD
ROCKFORD IL
61107-2201
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-9201
  • Fax:
Mailing address:
  • Phone: 779-696-9201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085006434
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: