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General NPI Number Information
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NPI Number | 1083163638
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Entity Type | Individual
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Provider Name | LANCE KENNEDY HARRIS PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/23/2016
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Last Update Date | 07/24/2019
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Provider Practice Location Address
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Address Line | 1555 EXCHANGE AVE
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City | CONWAY
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State | AR
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Zip | 72032-7824
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Country | US
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Telephone | 501-585-2400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 83
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City | MABELVALE
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State | AR
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Zip | 72103-0083
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Country | US
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Telephone | 573-450-4271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA-679
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License Number State | AR
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