Provider Demographics
NPI:1669636759
Name:HARDY, PEGGY MARIE (RN, PMHNP)
Entity type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:MARIE
Last Name:HARDY
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:MARIE
Other - Last Name:KOUASSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:73 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4809
Mailing Address - Country:US
Mailing Address - Phone:347-366-3519
Mailing Address - Fax:516-706-9394
Practice Address - Street 1:73 BROADWAY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-4809
Practice Address - Country:US
Practice Address - Phone:516-668-4581
Practice Address - Fax:516-612-2808
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242551-1163W00000X
NY402204363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse