Provider Demographics
NPI:1194723056
Name:HARDEN, KELLY ALEXANDRIA (DNSC, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ALEXANDRIA
Last Name:HARDEN
Suffix:
Gender:F
Credentials:DNSC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERN
Mailing Address - State:TN
Mailing Address - Zip Code:38059-1214
Mailing Address - Country:US
Mailing Address - Phone:731-627-0734
Mailing Address - Fax:731-627-0736
Practice Address - Street 1:105 N MONROE ST
Practice Address - Street 2:
Practice Address - City:NEWBERN
Practice Address - State:TN
Practice Address - Zip Code:38059-1214
Practice Address - Country:US
Practice Address - Phone:731-627-0734
Practice Address - Fax:731-627-0736
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902763Medicaid
TN39027641Medicare PIN
P26444Medicare UPIN
TN3902764Medicare ID - Type Unspecified