Provider Demographics
NPI:1821075235
Name:HARDY, ARTHUR WAYNE (FNP)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:WAYNE
Last Name:HARDY
Suffix:
Gender:M
Credentials:FNP
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 1249
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-1249
Mailing Address - Country:US
Mailing Address - Phone:928-536-4322
Mailing Address - Fax:
Practice Address - Street 1:815 N MAIN ST
Practice Address - Street 2:#D
Practice Address - City:TAYLOR
Practice Address - State:AZ
Practice Address - Zip Code:85939-1249
Practice Address - Country:US
Practice Address - Phone:928-536-4322
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN078308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52578Medicare UPIN
AZ68693Medicare PIN