Provider Demographics
NPI:1104662931
Name:HARDY, MELISSA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6373 N QUAIL HOLLOW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-1405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:871 RIDGEWAY LOOP RD STE 108
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-4026
Practice Address - Country:US
Practice Address - Phone:901-871-0170
Practice Address - Fax:901-871-0353
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906767363LP0808X
TN36773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health