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General NPI Number Information
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NPI Number | 1730579434
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Entity Type | Individual
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Provider Name | EBONY HAIRSTON FNP- C
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Gender | Female
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 200 GAMBLE DR
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City | LINCOLNTON
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State | NC
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Zip | 28092-4421
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Country | US
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Telephone | 704-736-8635
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Fax |
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Provider Business Mailing Address
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Address Line | 911 GOLDMINE HILL CT
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City | BELMONT
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State | NC
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Zip | 28012-4078
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Country | US
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Telephone | 937-603-4618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP7615
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5010217
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License Number State | NC
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