Provider Demographics
NPI:1508376914
Name:HAIRSTON, MANDESIA ROCHELLE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MANDESIA
Middle Name:ROCHELLE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E GREEN DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-6707
Mailing Address - Country:US
Mailing Address - Phone:336-641-3245
Mailing Address - Fax:
Practice Address - Street 1:501 E GREEN DR
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-6707
Practice Address - Country:US
Practice Address - Phone:336-641-3245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC241084363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily