Provider Demographics
NPI:1548247471
Name:HARDY, PAMELA (NP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2278
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28502-2278
Mailing Address - Country:US
Mailing Address - Phone:252-522-9800
Mailing Address - Fax:252-522-5520
Practice Address - Street 1:324 N QUEEN ST
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-4932
Practice Address - Country:US
Practice Address - Phone:252-522-9800
Practice Address - Fax:252-522-5520
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7000216Medicaid
NC500003551OtherRR MEDICARE
NC500003551OtherRR MEDICARE
NC7000216Medicaid