Healthcare Provider Details

I. General information

NPI: 1003710153
Provider Name (Legal Business Name): KAELYN HARDWICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 OAK PARK BLVD
LAKE CHARLES LA
70601-8911
US

IV. Provider business mailing address

302 STATE ST
LAKE CHARLES LA
70605-5622
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-3000
  • Fax:
Mailing address:
  • Phone: 337-499-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number234105
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: