Healthcare Provider Details

I. General information

NPI: 1154569820
Provider Name (Legal Business Name): RAGAN LYNN HURT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 COMMUNICATIONS PKWY STE 100
PLANO TX
75093-8906
US

IV. Provider business mailing address

3016 COMMUNICATIONS PKWY STE 100
PLANO TX
75093-8906
US

V. Phone/Fax

Practice location:
  • Phone: 972-964-7373
  • Fax: 972-964-3939
Mailing address:
  • Phone: 972-964-7373
  • Fax: 972-964-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06063
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: