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General NPI Number Information
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NPI Number | 1912526153
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Entity Type | Individual
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Provider Name | IANA G HARRIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 3414 GOLDEN RD
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City | TYLER
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State | TX
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Zip | 75701-8336
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Country | US
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Telephone | 903-939-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 117 CEDAR ELM LN
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City | GEORGETOWN
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State | TX
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Zip | 78633-1820
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Country | US
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Telephone |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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