Provider Demographics
NPI:1891582060
Name:TARDY, JENNIFER ANN (CHN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:TARDY
Suffix:
Gender:
Credentials:CHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105D SERENDIPITY WAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6979
Mailing Address - Country:US
Mailing Address - Phone:803-556-2593
Mailing Address - Fax:803-860-1499
Practice Address - Street 1:105D SERENDIPITY WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-6979
Practice Address - Country:US
Practice Address - Phone:803-556-2593
Practice Address - Fax:803-860-1499
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty