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General NPI Number Information
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NPI Number | 1417371949
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Entity Type | Individual
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Provider Name | TIMOTHY NOBLE HARKINS MS, PA-C, ATC
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Gender | Male
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Dates
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Enumeration Date | 02/04/2014
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Last Update Date | 04/11/2021
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Provider Practice Location Address
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Address Line | 1475 RAIDERS WAY
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City | HENDERSON
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State | NV
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Zip | 89052-4604
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Country | US
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Telephone | 725-780-3406
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Fax | 725-780-3540
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Provider Business Mailing Address
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Address Line | 1235 DIAMOND VALLEY ST
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City | HENDERSON
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State | NV
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Zip | 89052-3019
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Country | US
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Telephone | 510-305-2991
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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 | PA56353
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2175
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License Number State | NV
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