Healthcare Provider Details

I. General information

NPI: 1932675758
Provider Name (Legal Business Name): JASON LAMARR HARDIN MSN, APRN, AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 E W T HARRIS BLVD
CHARLOTTE NC
28215-4084
US

IV. Provider business mailing address

6010 E W T HARRIS BLVD
CHARLOTTE NC
28215-4084
US

V. Phone/Fax

Practice location:
  • Phone: 704-208-4134
  • Fax: 704-248-8068
Mailing address:
  • Phone: 704-208-4134
  • Fax: 704-248-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number5011129
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5011129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: