Provider Demographics
NPI:1669488649
Name:HARDY, KAREN LATRELLE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LATRELLE
Last Name:HARDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:KAREN
Other - Middle Name:HARDY
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 RICHLAND MEDICAL PARK
Mailing Address - Street 2:PALMETTO SENIOR CARE STE 203
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-3770
Mailing Address - Fax:803-434-3773
Practice Address - Street 1:1308 LAUREL STREET
Practice Address - Street 2:PALMETTO SENIOR CARE LAUREL
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-931-8166
Practice Address - Fax:803-931-8183
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA08185770Medicare ID - Type Unspecified
Q42074Medicare UPIN