MEDICARE: ANGELA LARABY HARRIS 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	PA2858	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376217737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA LARABY HARRIS PA

Provider Business Mailing Address
First Line	:	1221 S BROADWAY
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2701
Country	:	US
Telephone Number	:	859-258-6200
Fax Number	:	859-258-6203

Provider Business Practice Location Address
First Line	:	101 MEDICAL HEIGHTS DR STE D
Second Line	:
City	:	FRANKFORT
State	:	KY
Zip	:	40601-4137
Country	:	US
Telephone Number	:	502-226-7054
Fax Number	:	859-258-8919

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

Provider Enumeration Date	:	08/08/2021
Last Update Date	:	05/08/2026

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