Healthcare Provider Details

I. General information

NPI: 1053961318
Provider Name (Legal Business Name): HARDY HOUSE YOUR FAMILY HEALTHCARE PROVIDER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2747 BARTLETT BLVD
BARTLETT TN
38134-4580
US

IV. Provider business mailing address

4165 PINE HILL CV N
LAKELAND TN
38002-8111
US

V. Phone/Fax

Practice location:
  • Phone: 901-748-5308
  • Fax: 901-529-7716
Mailing address:
  • Phone: 901-229-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LATONYA S HARDY
Title or Position: DOCTOR OF NURSING PRACTICE/OWNER
Credential: DNP
Phone: 901-748-5308