Provider Demographics
NPI:1790135978
Name:ANDERSON, KELLY HARDMAN (DO)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:HARDMAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:NICOLE
Other - Last Name:HARDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1213 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2057
Mailing Address - Country:US
Mailing Address - Phone:704-219-8213
Mailing Address - Fax:
Practice Address - Street 1:1213 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2057
Practice Address - Country:US
Practice Address - Phone:704-219-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5151011036207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology