Provider Demographics
NPI:1891426656
Name:HARDEMAN, MAKAYLA NICOLE (WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MAKAYLA
Middle Name:NICOLE
Last Name:HARDEMAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 FAIRVIEW PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2567
Mailing Address - Country:US
Mailing Address - Phone:478-246-4304
Mailing Address - Fax:
Practice Address - Street 1:104 FAIRVIEW PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2567
Practice Address - Country:US
Practice Address - Phone:478-246-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN274807363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health