Provider Demographics
NPI:1023092418
Name:HARDIN, JULIA KAY M (APN)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:KAY M
Last Name:HARDIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:KAY
Other - Middle Name:M
Other - Last Name:HARDIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:403 W OAK ST
Mailing Address - Street 2:STE 303
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-862-5732
Mailing Address - Fax:870-863-8802
Practice Address - Street 1:403 W OAK ST
Practice Address - Street 2:STE 303
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-4586
Practice Address - Country:US
Practice Address - Phone:870-862-5732
Practice Address - Fax:870-863-8802
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR20627163W00000X
ARA01412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139246758Medicaid
AR139246758Medicaid
AR5U639Medicare PIN