MEDICARE: YVONNE HARDIN AGNP

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	363L00000X	Nurse Practitioner	AP125778	TX
2	363L00000X	Nurse Practitioner	209009969	IL
3	363LA2200X	Adult Health Nurse Practitioner	AP125778	TX

General Provider Information

NPI Number	:	1306188289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE HARDIN AGNP

Provider Business Mailing Address
First Line	:	115 W BROADWAY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1205
Country	:	US
Telephone Number	:	309-981-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 W BROADWAY AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-1205
Country	:	US
Telephone Number	:	309-981-9953
Fax Number	:

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

Provider Enumeration Date	:	03/19/2013
Last Update Date	:	09/01/2016

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