Provider Demographics
NPI:1154569820
Name:HURT, RAGAN LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:RAGAN
Middle Name:LYNN
Last Name:HURT
Suffix:
Gender:F
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 1:3016 COMMUNICATIONS PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8906
Mailing Address - Country:US
Mailing Address - Phone:972-964-7373
Mailing Address - Fax:972-964-3939
Practice Address - Street 1:3016 COMMUNICATIONS PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8906
Practice Address - Country:US
Practice Address - Phone:972-964-7373
Practice Address - Fax:972-964-3939
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L12157Medicare PIN