MEDICARE: MRS. PATTI SHAWN HARDESTY CNS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	504702	TX

General Provider Information

NPI Number	:	1174835979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PATTI SHAWN HARDESTY CNS

Provider Business Mailing Address
First Line	:	5500 GUHN RD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77040-6161
Country	:	US
Telephone Number	:	713-783-8889
Fax Number	:	713-953-0471

Provider Business Practice Location Address
First Line	:	5500 GUHN RD
Second Line	:	SUITE 100
City	:	HOUSTON
State	:	TX
Zip	:	77040-6161
Country	:	US
Telephone Number	:	713-783-8889
Fax Number	:	713-953-0471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	05/01/2013

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