Provider Demographics
NPI:1023015724
Name:HARRISON, SCOTT (PA)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 SINGING OAKS STE 200
Mailing Address - Street 2:
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6533
Mailing Address - Country:US
Mailing Address - Phone:830-980-8433
Mailing Address - Fax:830-980-8442
Practice Address - Street 1:524 SINGING OAKS STE 200
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78070-6533
Practice Address - Country:US
Practice Address - Phone:830-980-8433
Practice Address - Fax:830-980-8442
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2035313-02OtherWELLMED MEDICAID
TX362345YLPSOtherWELLMED MEDICARE
TX362345YLPSOtherWELLMED MEDICARE