1023092418 NPI number — MRS. JULIA KAY M HARDIN APN

Table of content: MRS. JULIA KAY M HARDIN APN (NPI 1023092418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023092418 NPI number — MRS. JULIA KAY M HARDIN APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDIN
Provider First Name:
JULIA
Provider Middle Name:
KAY M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARDIN
Provider Other First Name:
KAY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023092418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 W OAK ST
Provider Second Line Business Mailing Address:
STE 303
Provider Business Mailing Address City Name:
EL DORADO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-862-5732
Provider Business Mailing Address Fax Number:
870-863-8802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 W OAK ST
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
EL DORADO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71730-4586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-862-5732
Provider Business Practice Location Address Fax Number:
870-863-8802
Provider Enumeration Date:
11/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  R20627 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: A01412 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 139246758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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