Provider Demographics
NPI:1639138753
Name:HARDEY, KIM ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:ANTHONY
Last Name:HARDEY
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1211 COOLIDGE AVE
Mailing Address - Street 2:SUITE 403 KIM A HARDEY MD
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:337-261-5433
Mailing Address - Fax:337-269-9652
Practice Address - Street 1:1211 COOLIDGE AVE
Practice Address - Street 2:SUITE 403 KIM A HARDEY MD
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-261-5433
Practice Address - Fax:337-269-9652
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA16206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1345911Medicaid
LA5U078Medicare ID - Type Unspecified
LA1345911Medicaid