Provider Demographics
NPI:1174057640
Name:O'HERRON, MARGERY SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:MARGERY
Middle Name:SCOTT
Last Name:O'HERRON
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 1:200 HEALTH PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4679
Mailing Address - Country:US
Mailing Address - Phone:919-773-1223
Mailing Address - Fax:
Practice Address - Street 1:200 HEALTH PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4679
Practice Address - Country:US
Practice Address - Phone:919-773-1223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant