Provider Demographics
NPI:1356580070
Name:HARDY, KELLI D (RN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:D
Last Name:HARDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-8055
Mailing Address - Country:US
Mailing Address - Phone:334-361-3188
Mailing Address - Fax:
Practice Address - Street 1:602 S LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-4787
Practice Address - Country:US
Practice Address - Phone:334-293-7505
Practice Address - Fax:334-293-7374
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-093494163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse