MEDICARE: MRS. MELANIE R. HARRISON PA-C

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	363A00000X	Physician Assistant		TN
2	207P00000X	Emergency Medicine Physician	1494	TN
3	363AS0400X	Surgical Physician Assistant	1494	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326178138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE R. HARRISON PA-C

Provider Business Mailing Address
First Line	:	1 PROFESSIONAL PARK DR
Second Line	:	SUITE 21
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6587
Country	:	US
Telephone Number	:	423-946-4163
Fax Number	:	423-232-6903

Provider Business Practice Location Address
First Line	:	1 PROFESSIONAL PARK DR
Second Line	:	SUITE 21
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-6587
Country	:	US
Telephone Number	:	423-946-4163
Fax Number	:	423-232-6903

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/24/2013

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Directions to “ MRS. MELANIE R. HARRISON PA-C” Practice Location

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