Provider Demographics
NPI:1467406157
Name:HARDWICK, KIM SHARON (RPA-C)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:SHARON
Last Name:HARDWICK
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FOSTER RD
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533-6123
Mailing Address - Country:US
Mailing Address - Phone:845-262-4590
Mailing Address - Fax:855-200-2625
Practice Address - Street 1:45 FOSTER RD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533-6123
Practice Address - Country:US
Practice Address - Phone:845-226-4590
Practice Address - Fax:855-200-2625
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009857363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02617458Medicaid
NY02617458Medicaid
NYA400011347Medicare PIN