MEDICARE: MRS. NICOLE LYNN HARMON PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1003634536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE LYNN HARMON PA

Provider Business Mailing Address
First Line	:	184 GLADE RD
Second Line	:
City	:	CUMBERLAND GAP
State	:	TN
Zip	:	37724-4233
Country	:	US
Telephone Number	:	618-334-2054
Fax Number	:

Provider Business Practice Location Address
First Line	:	184 GLADE RD
Second Line	:
City	:	CUMBERLAND GAP
State	:	TN
Zip	:	37724-4233
Country	:	US
Telephone Number	:	618-334-2054
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/02/2024

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