Provider Demographics
NPI:1609674449
Name:HARGROVE, CHRISTIAN ANTIONETTE
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:ANTIONETTE
Last Name:HARGROVE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3233
Mailing Address - Country:US
Mailing Address - Phone:919-339-4067
Mailing Address - Fax:
Practice Address - Street 1:315 W SPRING ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3233
Practice Address - Country:US
Practice Address - Phone:252-767-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172A00000X, 373H00000X
NC516817376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No376K00000XNursing Service Related ProvidersNurse's Aide