Individual
ALEXA LALIBERTE FAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
100 KELLIE DR, SMITHFIELD, NC 27577-9444
(919) 934-1094
Mailing address
PO BOX 5105, BELFAST, ME 04915-5100
(919) 220-5255
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-12568
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010-12568
MEDICAL LICENSE
NC
Enumeration date
03/10/2022
Last updated
09/08/2022
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