Provider Demographics
NPI:1366441149
Name:MCLAURIN, GRACE (PA-C)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MCLAURIN
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 1:74 8TH STREET SE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4942
Mailing Address - Country:US
Mailing Address - Phone:828-322-1498
Mailing Address - Fax:828-322-2835
Practice Address - Street 1:74 8TH STREET SE
Practice Address - Street 2:SUITE 101
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4942
Practice Address - Country:US
Practice Address - Phone:828-322-1498
Practice Address - Fax:828-322-2835
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101986363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS10123Medicare UPIN
NC2749028Medicare ID - Type Unspecified