MEDICARE: MS. KAREN LATRELLE HARDY FNP

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	363LF0000X	Family Nurse Practitioner	APN760	SC

General Provider Information

NPI Number	:	1669488649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN LATRELLE HARDY FNP

Provider Business Mailing Address
First Line	:	15 RICHLAND MEDICAL PARK
Second Line	:	PALMETTO SENIOR CARE STE 203
City	:	COLUMBIA
State	:	SC
Zip	:	29203
Country	:	US
Telephone Number	:	803-434-3770
Fax Number	:	803-434-3773

Provider Business Practice Location Address
First Line	:	1308 LAUREL STREET
Second Line	:	PALMETTO SENIOR CARE LAUREL
City	:	COLUMBIA
State	:	SC
Zip	:	29201
Country	:	US
Telephone Number	:	803-931-8166
Fax Number	:	803-931-8183

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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