Healthcare Provider Details

I. General information

NPI: 1497677561
Provider Name (Legal Business Name): LANDON M HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 ROSE ST
LEXINGTON KY
40356
US

IV. Provider business mailing address

233 SYCAMORE RD APT 1
LEXINGTON KY
40502-1884
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6161
  • Fax:
Mailing address:
  • Phone: 859-652-1622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: