Provider Demographics
NPI:1871948166
Name:HARDEN, STEFANIE K (PA)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:K
Last Name:HARDEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 E. TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-675-1313
Mailing Address - Fax:888-965-0619
Practice Address - Street 1:5400 E. TEXAS ST
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-675-1313
Practice Address - Fax:888-965-0619
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2994363A00000X, 363AM0700X
LA325471363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3709163Medicaid