Kenyetta Hardy, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C012640 Issued in NC

Practice address

1647 NE Ashley School Cir
Winston Salem, NC 27105-5444

Phone

(336) 703-4203

NPI assigned

Jun 15, 2017

Last updated

Aug 23, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Opportunities Industrialization Center, Inc.

  dba Oic Family Medical Center Guardian Court

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
  • NPI 1396103305
  Medicare reassignment NPD
• Opportunities Industrialization Center, Inc

  dba Oic Family Medical Center LTC

  • Federally Qualified Health Center (FQHC)
  • Rocky Mount, NC
  • NPI 1932923950
  NPD

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

{
    "created_epoch": "1497484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1407386907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 2ND AVE",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280524358",
            "telephone_number": "704-874-9005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1647 NE ASHLEY SCHOOL CIR",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271055444",
            "telephone_number": "336-703-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDY",
        "first_name": "KENYETTA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-15",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P011541",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C012640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Steven Hardie, M.D.
• Ceshae Cemonique Alexia Harding, MD
• Elijah Matthew Harding
• Casey Leigh Hardy, NP
• Eliza Claire Hardy, MD
• Samantha Hardy, RN, CRNA
• Mitchell James Hargis, MD
• Katherine Hargitt, LCAS
• Mya Hargrove
• Prakash Harikrishnan

• Clinical Social Worker in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.