Healthcare Provider Details

I. General information

NPI: 1376217737
Provider Name (Legal Business Name): ANGELA LARABY HARRIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MEDICAL HEIGHTS DR STE D
FRANKFORT KY
40601-4137
US

IV. Provider business mailing address

1221 S BROADWAY
LEXINGTON KY
40504-2701
US

V. Phone/Fax

Practice location:
  • Phone: 502-226-7054
  • Fax: 859-258-8919
Mailing address:
  • Phone: 859-258-6200
  • Fax: 859-258-6203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2858
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: