Provider Demographics
NPI:1265012751
Name:HARDY, KOKISHA SHADAY
Entity Type:Individual
Prefix:MISS
First Name:KOKISHA
Middle Name:SHADAY
Last Name:HARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 E FLAMINGO RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5270
Mailing Address - Country:US
Mailing Address - Phone:702-562-3355
Mailing Address - Fax:702-369-8284
Practice Address - Street 1:4701 E SAHARA AVE APT 300
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-6342
Practice Address - Country:US
Practice Address - Phone:909-566-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician