Provider Demographics
NPI:1174636195
Name:HARDY, JOANNA MICHELLE (FNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MICHELLE
Last Name:HARDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:HARDY THOMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2117 BROADWAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3210
Mailing Address - Country:US
Mailing Address - Phone:601-288-8050
Mailing Address - Fax:601-288-8058
Practice Address - Street 1:2117 BROADWAY DRIVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3210
Practice Address - Country:US
Practice Address - Phone:601-288-8050
Practice Address - Fax:601-288-8058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR803993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891010340Medicaid
MS09483506Medicaid