Healthcare Provider Details

I. General information

NPI: 1457359473
Provider Name (Legal Business Name): ELIZABETH ANNE HARRIS PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 N COMANCHE AVE
WARR ACRES OK
73132-6698
US

IV. Provider business mailing address

2756 LANCASTER LN
OKLAHOMA CITY OK
73116-4417
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4646
  • Fax: 405-271-4242
Mailing address:
  • Phone: 405-271-4646
  • Fax: 405-271-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA672
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: