Healthcare Provider Details

I. General information

NPI: 1194310938
Provider Name (Legal Business Name): KARLEIGH BLAISE HARRELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S VINE ST
BASTROP LA
71220-4513
US

IV. Provider business mailing address

425 S VINE ST
BASTROP LA
71220-4513
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-8414
  • Fax:
Mailing address:
  • Phone: 318-388-8414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number346285
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: