NPIMap

Individual provider Active NPI

Charlie M Hardin Jr., CFNP/ACNP

  • Acute Care Nurse Practitioner
  • Walnut Grove, MS
National Provider Identifier
1669450037
Registry record updated Mar 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R857156 Issued in MS
Practice address
110 Park Street
Walnut Grove, MS 39189
Phone
(601) 253-0173
Fax
(601) 253-0176
NPI assigned
Jan 5, 2006
Last updated
Mar 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R857156 MS Primary

Addresses

Primary practice location

110 Park Street
Walnut Grove, MS 39189

Mailing address

965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446
Phone (901) 227-3255

Other identifiers 1

IdentifierTypeStateIssuer
03239875MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040803001282 MS Practitioner - Nurse Practitioner 8628049681 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

110 Park St
Walnut Grove, MS 39189-6526
Phone (601) 253-0173

1100 Hwy 16 E
Carthage, MS 39051-4222
Phone (601) 267-1470

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Medical Center-Leake, Inc. CurrentSince Nov 11, 2013 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince Oct 5, 2018 Accepting new patients
Baptist Medical Center-Leake, Inc Current Accepting new patients
Baptist Medical Center-Leake, Inc CurrentSince Nov 11, 2013 Accepting new patients
Independent Healthcare Management, Inc. CurrentSince Oct 5, 2018 Accepting new patients
Independent Healthcare Management, Inc. PastSince Aug 15, 2021 Accepting new patients
Neshoba County General Hospital Past Accepting new patients
University Surgery Associates, PLLC Past Accepting new patients
Carthage Senior Care Past Accepting new patients
Baptist Medical Center-Leake, Inc Past Accepting new patients

Locations

302 Ellis St
Carthage, MS 39051
Phone (601) 267-1100

310 Ellis St
Carthage, MS 39051
Phone (601) 267-1100

330 N Broad St
Forest, MS 39074
Phone (601) 469-4151

330 N Broad St
#S
Forest, MS 39074
Phone (601) 469-4151

526 Deerfield Dr
Unit C
Forest, MS 39074
Phone (601) 469-0291

Interoperability endpoints

  • Direct secure messaging: chardin154808@direct.bmhcc.org

Organizations & group practices 10

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.

Hospital & facility affiliations 3

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": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520380800000",
    "number": "1669450037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "965 RIDGE LAKE BLVD STE 103",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209446",
            "telephone_number": "901-227-3255",
            "fax_number": "901-227-8591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 PARK STREET",
            "city": "WALNUT GROVE",
            "state": "MS",
            "postal_code": "39189",
            "telephone_number": "601-253-0173",
            "fax_number": "601-253-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARDIN",
        "first_name": "CHARLIE",
        "middle_name": "M",
        "name_suffix": "Jr.",
        "credential": "CFNP/ACNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2018-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "R857156",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03239875",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walnut Grove, MS

Sources for this page

Verify at the official NPI Registry.