Provider Demographics
NPI:1538176805
Name:HARDY, BRENDA MOZETTE (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MOZETTE
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 KIRBY RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-8221
Mailing Address - Country:US
Mailing Address - Phone:901-345-4640
Mailing Address - Fax:901-399-7973
Practice Address - Street 1:2900 KIRBY RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-8221
Practice Address - Country:US
Practice Address - Phone:901-345-4640
Practice Address - Fax:901-399-7973
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020350207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4041571OtherBLUECROSS/BLUE SHIELD
TN3812313Medicaid
TN3380200Medicare ID - Type Unspecified
TN4041571OtherBLUECROSS/BLUE SHIELD