Provider Demographics
NPI:1255826830
Name:HARRELSON, MEGGAN FARNSWORTH (AGNP)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:FARNSWORTH
Last Name:HARRELSON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1771 TATE BLVD SE
Mailing Address - Street 2:STE 103
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4250
Mailing Address - Country:US
Mailing Address - Phone:336-716-3346
Mailing Address - Fax:
Practice Address - Street 1:1771 TATE BLVD SE STE 103
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4250
Practice Address - Country:US
Practice Address - Phone:828-322-1128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5010658363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner