Provider Demographics
NPI:1154927606
Name:HARDY, KELLIE L (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:L
Last Name:HARDY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746874
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6874
Mailing Address - Country:US
Mailing Address - Phone:913-951-8731
Mailing Address - Fax:
Practice Address - Street 1:700 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2111
Practice Address - Country:US
Practice Address - Phone:913-951-8731
Practice Address - Fax:913-426-9057
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79804-051363L00000X
MO2020039162363L00000X, 363LF0000X
KS5379804051363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner