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General NPI Number Information
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NPI Number | 1356580070
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Entity Type | Individual
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Provider Name | KELLI D. HARDY RN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 602 S LAWRENCE ST
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City | MONTGOMERY
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State | AL
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Zip | 36104-4787
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Country | US
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Telephone | 334-293-7505
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Fax | 334-293-7374
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Provider Business Mailing Address
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Address Line | 707 YELLOWSTONE DR
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City | PRATTVILLE
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State | AL
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Zip | 36067-8055
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Country | US
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Telephone | 334-361-3188
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1-093494
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License Number State | AL
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