Healthcare Provider Details

I. General information

NPI: 1043145089
Provider Name (Legal Business Name): LARA PRIDGEN ADN,RN,NC-CPHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 238
COLUMBIA NC
27925-0238
US

IV. Provider business mailing address

PO BOX 238
COLUMBIA NC
27925-0238
US

V. Phone/Fax

Practice location:
  • Phone: 252-793-1750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number247064
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: