Healthcare Provider Details

I. General information

NPI: 1922703651
Provider Name (Legal Business Name): REBECCA LYNN HARDY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN SIMON

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 OLD CANTON RD
MADISON MS
39110-9299
US

IV. Provider business mailing address

2500 N STATE ST
JACKSON MS
39216-4500
US

V. Phone/Fax

Practice location:
  • Phone: 888-815-2005
  • Fax:
Mailing address:
  • Phone: 888-815-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37022
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: