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General NPI Number Information
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NPI Number | 1609430842
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Entity Type | Individual
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Provider Name | WILLIAM TAYLOR HARDY DNP
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Gender | Male
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Dates
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Enumeration Date | 04/23/2019
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 401 SOUTHCREST CIR STE 201
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City | SOUTHAVEN
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State | MS
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Zip | 38671
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Country | US
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Telephone | 901-226-0456
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Fax |
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Provider Business Mailing Address
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Address Line | 965 RIDGE LAKE BLVD STE 103
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City | MEMPHIS
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State | TN
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Zip | 38120-9446
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Country | US
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Telephone | 901-227-3255
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 903278
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License Number State | MS
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