Healthcare Provider Details

I. General information

NPI: 1992730766
Provider Name (Legal Business Name): KENNETH L HARDING JR. C.R.N.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1373 E STATE ROAD 62
MADISON IN
47250-7328
US

IV. Provider business mailing address

PO BOX 189
MADISON IN
47250-0189
US

V. Phone/Fax

Practice location:
  • Phone: 812-801-0156
  • Fax: 812-801-0276
Mailing address:
  • Phone: 812-801-0156
  • Fax: 812-801-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28080093
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: