Provider Demographics
NPI:1033111901
Name:HARDCASTLE, SHELLIE D (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHELLIE
Middle Name:D
Last Name:HARDCASTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 GREENHILL RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9893
Mailing Address - Country:US
Mailing Address - Phone:270-745-1808
Mailing Address - Fax:270-796-5516
Practice Address - Street 1:250 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1760
Practice Address - Country:US
Practice Address - Phone:270-745-1808
Practice Address - Fax:270-796-5516
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF96276Medicaid
KYP28696Medicare UPIN