Provider Demographics
NPI:1922297001
Name:HARDY, JAMES LEROY (PA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LEROY
Last Name:HARDY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1225 CAMPBELL WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3323
Mailing Address - Country:US
Mailing Address - Phone:360-479-4203
Mailing Address - Fax:360-479-7240
Practice Address - Street 1:1225 CAMPBELL WAY STE 101
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3323
Practice Address - Country:US
Practice Address - Phone:360-479-4203
Practice Address - Fax:360-479-7240
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60002566363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1093191Medicaid
WA374005OtherLABOR & INDUSTRIES