Provider Demographics
NPI:1891228839
Name:EARNHARDT, LOU ANN (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:ANN
Last Name:EARNHARDT
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:LOU
Other - Middle Name:ANN
Other - Last Name:LATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1315 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7317
Mailing Address - Country:US
Mailing Address - Phone:336-848-8250
Mailing Address - Fax:737-226-6750
Practice Address - Street 1:1900 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-4220
Practice Address - Country:US
Practice Address - Phone:737-226-6700
Practice Address - Fax:737-226-6750
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC254702163W00000X
NC5009475363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse