MEDICARE: ANDREA K HARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1124980651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA K HARRISON

Provider Business Mailing Address
First Line	:	1025 S 1200 W
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9349
Country	:	US
Telephone Number	:	260-479-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 S 1200 W
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9349
Country	:	US
Telephone Number	:	260-479-8015
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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