Provider Demographics
NPI:1568409829
Name:HARDY, CONSTANCE ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:ALEXIS
Last Name:HARDY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 BROOKSIDE DR
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4627
Mailing Address - Country:US
Mailing Address - Phone:423-857-5905
Mailing Address - Fax:423-857-5904
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-347-4570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0522207R00000X
TN39955207R00000X
ND21979208M00000X
MN78579208M00000X
MO2025003953208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4111406OtherBLUE CROSS
TN3335549Medicaid
TN4153179OtherBLUE CROSS
TN3335540Medicaid
TNP00287028OtherRAILROAD MEDICARE
VA1568409829Medicaid
VA1568409829Medicaid
TN4153179OtherBLUE CROSS
TN3335540Medicare PIN