Provider Demographics
NPI:1952311391
Name:HASTING, STEPHEN R (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:R
Last Name:HASTING
Suffix:
Gender:M
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 1:724 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4822
Mailing Address - Country:US
Mailing Address - Phone:919-776-6767
Mailing Address - Fax:
Practice Address - Street 1:724 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4822
Practice Address - Country:US
Practice Address - Phone:919-776-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA911363A00000X, 363AM0700X
NC0010-10286363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100870Medicare ID - Type Unspecified
NVQ10774Medicare UPIN