Healthcare Provider Details

I. General information

NPI: 1053824573
Provider Name (Legal Business Name): LAMONICA HARRISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 BARKER CYPRESS RD
CYPRESS TX
77433-1372
US

IV. Provider business mailing address

9450 SW GEMINI DR, PMB49084
BEAVERTON OR
97008
US

V. Phone/Fax

Practice location:
  • Phone: 281-367-0400
  • Fax: 832-220-1661
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11627
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: