Healthcare Provider Details

I. General information

NPI: 1114811346
Provider Name (Legal Business Name): KELLIE MARIE HARDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E BROAD ST
COLUMBUS OH
43213-1502
US

IV. Provider business mailing address

8980 ALSPACH RD NW
CANAL WINCHESTER OH
43110-3500
US

V. Phone/Fax

Practice location:
  • Phone: 613-234-6000
  • Fax:
Mailing address:
  • Phone: 614-849-8194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0039634
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.443670
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: