Healthcare Provider Details

I. General information

NPI: 1386924389
Provider Name (Legal Business Name): KIMBERLY MARIE HARDIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S LIMESTONE ST CTW 324 E
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

129 LANTERN WAY
NICHOLASVILLE KY
40356-9713
US

V. Phone/Fax

Practice location:
  • Phone: 859-608-8073
  • Fax:
Mailing address:
  • Phone: 859-433-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3007090
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: