Provider Demographics
NPI:1609979855
Name:HARDY, PAULA K (ANP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:K
Last Name:HARDY
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3139
Mailing Address - Country:US
Mailing Address - Phone:719-475-5065
Mailing Address - Fax:719-475-5797
Practice Address - Street 1:2350 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3139
Practice Address - Country:US
Practice Address - Phone:719-475-5065
Practice Address - Fax:719-475-5797
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP06062163WG0000X
OHCOA06062NP363L00000X
COAPN0992240-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAPN0992240-NPOtherCO LICENSE
OH2550494Medicaid
OHCOA06062NPOtherOHIO LICENSE
OH2550494Medicaid
OHHANP17802Medicare PIN
COAPN0992240-NPOtherCO LICENSE