Provider Demographics
NPI:1053302844
Name:HARDIN, LAURA ASHLEY (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ASHLEY
Last Name:HARDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-3023
Mailing Address - Country:US
Mailing Address - Phone:479-267-1001
Mailing Address - Fax:479-267-1026
Practice Address - Street 1:5 MEDICAL PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3732
Practice Address - Country:US
Practice Address - Phone:501-315-7620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3785207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154263001Medicaid
AR5M717Medicare ID - Type Unspecified
ARH97859Medicare UPIN