Healthcare Provider Details

I. General information

NPI: 1497348155
Provider Name (Legal Business Name): LORA HARGETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2021
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 W WILLIAMS ST STE 102
APEX NC
27502-3979
US

IV. Provider business mailing address

2422 BELLWYND DR APT 2422
APEX NC
27539-3011
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-8409
  • Fax: 877-622-8953
Mailing address:
  • Phone: 813-205-6108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113714
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0000004359
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10854
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: