Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 3017203 | KY |
NPI | 1073265013 |
---|---|
Provider Name | Marcella Nicole Hardy |
First Address | Mount Washington, KY 40047-7778 |
Second Address | Mount Washington, KY 40047-7778 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |