=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548247471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAMELA HARDY NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2005
-----------------------------------------------------
Last Update Date | 02/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 324 N QUEEN ST
-----------------------------------------------------
City | KINSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28501-4932
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-522-9800
-----------------------------------------------------
Fax | 252-522-5520
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2278
-----------------------------------------------------
City | KINSTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28502-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 252-522-9800
-----------------------------------------------------
Fax | 252-522-5520
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 200053
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------