Provider Demographics
NPI:1104601301
Name:HARDIN, RACHEAL (NP)
Entity type:Individual
Prefix:
First Name:RACHEAL
Middle Name:
Last Name:HARDIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SACAJEWA DR
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-6628
Mailing Address - Country:US
Mailing Address - Phone:409-739-1099
Mailing Address - Fax:
Practice Address - Street 1:17080 HIGHWAY 3
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4129
Practice Address - Country:US
Practice Address - Phone:281-557-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139515363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner