Provider Demographics
NPI:1699961144
Name:HARDCASTLE, LAURA BETHANY (APN)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BETHANY
Last Name:HARDCASTLE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 SHUN PIKE
Mailing Address - Street 2:
Mailing Address - City:COTTONTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37048-5018
Mailing Address - Country:US
Mailing Address - Phone:270-776-1342
Mailing Address - Fax:
Practice Address - Street 1:165 NATCHEZ TRACE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-7940
Practice Address - Country:US
Practice Address - Phone:270-282-2024
Practice Address - Fax:270-282-2027
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY300724363L00000X
TN12693363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner