Provider Demographics
NPI:1053961318
Name:HARDY HOUSE YOUR FAMILY HEALTHCARE PROVIDER, PLLC
Entity type:Organization
Organization Name:HARDY HOUSE YOUR FAMILY HEALTHCARE PROVIDER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF NURSING PRACTICE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:901-748-5308
Mailing Address - Street 1:4165 PINE HILL CV N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-8111
Mailing Address - Country:US
Mailing Address - Phone:901-229-1787
Mailing Address - Fax:
Practice Address - Street 1:2747 BARTLETT BLVD
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-4580
Practice Address - Country:US
Practice Address - Phone:901-748-5308
Practice Address - Fax:901-529-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty