Provider Demographics
NPI:1073079430
Name:HARDAWAY, KATHRYN (NP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:HARDAWAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:CARLISLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:520 MEDICAL CENTER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4334
Mailing Address - Country:US
Mailing Address - Phone:541-789-5710
Mailing Address - Fax:
Practice Address - Street 1:520 MEDICAL CENTER DR STE 201
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4334
Practice Address - Country:US
Practice Address - Phone:541-789-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-11
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN261173163W00000X
OR201901189RN163W00000X
OR201901242NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse