Provider Demographics
NPI:1144626706
Name:HARRISON, PREETHI S (PA-C)
Entity type:Individual
Prefix:MRS
First Name:PREETHI
Middle Name:S
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11520 HALEIWA PL
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-4133
Mailing Address - Country:US
Mailing Address - Phone:228-332-1502
Mailing Address - Fax:
Practice Address - Street 1:11520 HALEIWA PL
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-4133
Practice Address - Country:US
Practice Address - Phone:228-332-1502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant