Provider Demographics
NPI:1740799378
Name:HUNT, LARRA ASHLEY (AG-PCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LARRA
Middle Name:ASHLEY
Last Name:HUNT
Suffix:
Gender:F
Credentials:AG-PCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3186 VILLAGE DR
Mailing Address - Street 2:STE 201
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3979
Mailing Address - Country:US
Mailing Address - Phone:910-624-8333
Mailing Address - Fax:
Practice Address - Street 1:3186 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3978
Practice Address - Country:US
Practice Address - Phone:910-486-5700
Practice Address - Fax:910-486-5950
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner