Provider Demographics
NPI:1477097491
Name:HARDY, KERRY (RN,HNB-BC,RMT)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:RN,HNB-BC,RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4823
Mailing Address - Country:US
Mailing Address - Phone:203-895-5134
Mailing Address - Fax:
Practice Address - Street 1:655 RIVER RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4823
Practice Address - Country:US
Practice Address - Phone:203-895-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103930163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse