Provider Demographics
NPI:1114945953
Name:HALL, LISA MCCASKILL (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MCCASKILL
Last Name:HALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 WILKINS DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-7268
Mailing Address - Country:US
Mailing Address - Phone:919-776-6000
Mailing Address - Fax:
Practice Address - Street 1:2412 WILKINS DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-7268
Practice Address - Country:US
Practice Address - Phone:919-776-6000
Practice Address - Fax:919-580-0148
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00227363A00000X
TN1897363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP01339966OtherRAILROAD MEDICARE
Q63401Medicare UPIN
NCNCG750D273Medicare PIN