MEDICARE: ANGELA MARIE HARRISH PEDIATRIC NURSE PRAC

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	363LP0200X	Pediatric Nurse Practitioner	115839	CO
2	363LP0200X	Pediatric Nurse Practitioner	53-75721-112	KS

General Provider Information

NPI Number	:	1598825515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIE HARRISH PEDIATRIC NURSE PRAC

Provider Business Mailing Address
First Line	:	14011 BENSON STREET
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66221
Country	:	US
Telephone Number	:	913-912-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	5250 WEST 94TH TERRACE
Second Line	:
City	:	PRAIRIE VILLAGE
State	:	KS
Zip	:	66207
Country	:	US
Telephone Number	:	913-451-0000
Fax Number	:	913-491-0547

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

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	05/29/2019

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