Provider Demographics
NPI:1538447081
Name:LIBBY, ALICIA S (PAC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:S
Last Name:LIBBY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3000
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-3000
Mailing Address - Country:US
Mailing Address - Phone:910-715-3500
Mailing Address - Fax:910-715-3501
Practice Address - Street 1:OUTPATIENT CANCER CENTER
Practice Address - Street 2:220 PAGE ROAD
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-3000
Practice Address - Country:US
Practice Address - Phone:910-715-3500
Practice Address - Fax:910-715-3501
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004620363A00000X
GA6182363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant