Provider Demographics
NPI:1306388822
Name:HARDY, LAUREN GRACE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:GRACE
Last Name:HARDY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:CROSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:540 HERITAGE POINTE DR STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:540 HERITAGE POINTE DR STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-1006
Practice Address - Country:US
Practice Address - Phone:931-820-0242
Practice Address - Fax:833-551-4830
Is Sole Proprietor?:No
Enumeration Date:2016-11-15
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant