Individual provider Active NPI

Kathryn Hardaway, NP-C

  • Family Nurse Practitioner
  • Medford, OR
National Provider Identifier
1073079430
Registry record updated Apr 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
201901242NP-PP Issued in OR
Practice address
520 Medical Center Dr Ste 201
Medford, OR 97504-4334
Phone
(541) 789-5710
NPI assigned
Feb 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X RN261173 GA
Registered Nurse 163W00000X 201901189RN OR
Family Nurse Practitioner 363LF0000X 201901242NP-PP OR Primary

Addresses

Primary practice location

520 Medical Center Dr Ste 201
Medford, OR 97504-4334

Mailing address

520 Medical Center Dr Ste 201
Medford, OR 97504-4334
Phone (541) 789-5710

Other names 1

  • Kathryn Carlisle Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190711001851 OR Practitioner - Nurse Practitioner 4688909773 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Asante Physician PartnersGroup PAC ID 8325206246, 227 clinicians

Practice addresses (Care Compare)

2825 E Barnett Rd
Medford, OR 97504-8332
Phone (541) 789-7000

625 SW Ramsey Ave
Suite a
Grants Pass, OR 97527-5808
Phone (541) 507-2290

Hospital & facility affiliations

  • Asante Rogue Regional Medical Center Hospital, Medford, OR, CCN 380018
  • Asante Three Rivers Medical Center Hospital, Grants Pass, OR, CCN 380002
  • Fairchild Medical Center Hospital, Yreka, CA, CCN 051316
  • Asante Ashland Community Hospital Hospital, Ashland, OR, CCN 380005
  • Curry General Hospital Hospital, Gold Beach, OR, CCN 381322

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN261173GAMDRegistered Nurse
201901189RNORMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Asante Physician Partners CurrentSince Jun 3, 2019 Accepting new patients

Locations

625 SW Ramsey Ave
Ste A
Grants Pass, OR 97527
Phone (541) 474-5004

2620 E Barnett Rd
Ste H
Medford, OR 97504
Phone (541) 789-4281

555 Black Oak Dr
Medford, OR 97504
Phone (541) 734-3434

520 Medical Center Dr
Ste 201
Medford, OR 97504
Phone (541) 789-5710

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681776000000",
    "number": "1073079430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 MEDICAL CENTER DR STE 201",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044334",
            "telephone_number": "541-789-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MEDICAL CENTER DR STE 201",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975044334",
            "telephone_number": "541-789-5710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDAWAY",
        "first_name": "KATHRYN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-11",
        "last_updated": "2023-04-18",
        "certification_date": "2023-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN261173",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "201901189RN",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201901242NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "CARLISLE",
            "credential": "NP-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.