Healthcare Provider Details

I. General information

NPI: 1710659859
Provider Name (Legal Business Name): COURTNEY HARDY APRN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 N MAIN ST
BEAVER DAM KY
42320-8957
US

IV. Provider business mailing address

1325 TRIPLETT ST
OWENSBORO KY
42303-3163
US

V. Phone/Fax

Practice location:
  • Phone: 270-274-5601
  • Fax:
Mailing address:
  • Phone: 270-688-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number243697
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017158
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number243697
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: