Healthcare Provider Details

I. General information

NPI: 1336790989
Provider Name (Legal Business Name): JAMES A HARRISON RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 09/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 WILLIAMSBURG RD
LEXINGTON KY
40504-3014
US

IV. Provider business mailing address

1932 WILLIAMSBURG RD
LEXINGTON KY
40504-3014
US

V. Phone/Fax

Practice location:
  • Phone: 859-327-2020
  • Fax:
Mailing address:
  • Phone: 859-327-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1065346
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number1065346
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number1065346
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: