Provider Demographics
NPI:1225206436
Name:HARDIN, KELLY JANE (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JANE
Last Name:HARDIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:JANE
Other - Last Name:MILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:4401 S THOMPSON ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-7462
Practice Address - Country:US
Practice Address - Phone:479-756-1300
Practice Address - Fax:479-751-7013
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003090363LF0000X, 363LF0000X
ARATP000133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily