Provider Demographics
NPI:1730579434
Name:HAIRSTON, EBONY (FNP- C)
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:FNP- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 GOLDMINE HILL CT
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-4078
Mailing Address - Country:US
Mailing Address - Phone:937-603-4618
Mailing Address - Fax:
Practice Address - Street 1:200 GAMBLE DR
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4421
Practice Address - Country:US
Practice Address - Phone:704-736-8635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7615363LF0000X
NC5010217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily