Provider Demographics
NPI:1760084909
Name:HARDISON, JAMIE NICOLE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:NICOLE
Last Name:HARDISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-0579
Mailing Address - Country:US
Mailing Address - Phone:601-756-1215
Mailing Address - Fax:
Practice Address - Street 1:213 TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654-3648
Practice Address - Country:US
Practice Address - Phone:601-756-1215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider