Provider Demographics
NPI:1487261236
Name:HARDIN, KELLY DIANE (RN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DIANE
Last Name:HARDIN
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 1:1503 HOBSON ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2427
Mailing Address - Country:US
Mailing Address - Phone:509-301-2602
Mailing Address - Fax:
Practice Address - Street 1:1503 HOBSON ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2427
Practice Address - Country:US
Practice Address - Phone:509-301-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00126005163WG0600X, 163WI0500X, 163WM0705X, 163WN0800X, 163WC1500X, 163WP2201X, 163WR0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation