Individual provider Active NPI

Kelly Alexandria Harden, DNSC, FNP-BC

  • Family Nurse Practitioner
  • Newbern, TN
National Provider Identifier
1194723056
Registry record updated Jan 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Practice address
105 N Monroe St
Newbern, TN 38059-1214
Phone
(731) 627-0734
Fax
(731) 627-0736
NPI assigned
Jul 13, 2005
Last updated
Jan 21, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X TN Primary

Addresses

Primary practice location

105 N Monroe St
Newbern, TN 38059-1214

Mailing address

105 N Monroe St
Newbern, TN 38059-1214
Phone (731) 627-0734

Other identifiers 1

IdentifierTypeStateIssuer
3902763MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20071231000516 TN Practitioner - Nurse Practitioner 2567542731 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6246TNMDPhysical Therapist
APN 6256, RN 76571TNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Fast Pace Medical Clinic PLLC CurrentSince Jun 13, 2024 Accepting new patients
Fast Pace Medical Clinic PLLC CurrentSince Jun 13, 2024 Accepting new patients
Newbern Medical Clinic, PC CurrentSince Aug 21, 2011 Accepting new patients

Locations

2066 N Highland Ave
Jackson, TN 38305
Phone (731) 513-6250

105 N Monroe St
Newbern, TN 38059
Phone (731) 627-0734

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200873600000",
    "number": "1194723056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 N MONROE ST",
            "city": "NEWBERN",
            "state": "TN",
            "postal_code": "380591214",
            "telephone_number": "731-627-0734",
            "fax_number": "731-627-0736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 N MONROE ST",
            "city": "NEWBERN",
            "state": "TN",
            "postal_code": "380591214",
            "telephone_number": "731-627-0734",
            "fax_number": "731-627-0736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDEN",
        "first_name": "KELLY",
        "middle_name": "ALEXANDRIA",
        "name_prefix": "Mrs.",
        "credential": "DNSC, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-13",
        "last_updated": "2008-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3902763",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newbern, TN

Sources for this page

Verify at the official NPI Registry.