Provider Demographics
NPI:1346517497
Name:HARPER, ANDREA NOELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:NOELLE
Last Name:HARPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ANDREA
Other - Middle Name:NOELLE
Other - Last Name:BERGERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1309 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4422
Mailing Address - Country:US
Mailing Address - Phone:910-437-5130
Mailing Address - Fax:
Practice Address - Street 1:1309 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4422
Practice Address - Country:US
Practice Address - Phone:910-437-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101216Medicaid
NCNC3572AMedicare PIN