Provider Demographics
NPI:1619996246
Name:HARDIN, SARAH LEE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:LEE
Last Name:HARDIN
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 1:1420 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5916
Mailing Address - Country:US
Mailing Address - Phone:870-536-5541
Mailing Address - Fax:
Practice Address - Street 1:2306 RIKE DR
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-3933
Practice Address - Country:US
Practice Address - Phone:870-535-2142
Practice Address - Fax:870-534-8822
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01079363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440142901Medicaid