Provider Demographics
NPI:1033536115
Name:HARLIN, LESSIE JR (APRN)
Entity Type:Individual
Prefix:MR
First Name:LESSIE
Middle Name:
Last Name:HARLIN
Suffix:JR
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9252 COUNTY ROAD 408A
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:76050-4181
Mailing Address - Country:US
Mailing Address - Phone:817-690-1996
Mailing Address - Fax:
Practice Address - Street 1:9252 COUNTY ROAD 408A
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:TX
Practice Address - Zip Code:76050-4181
Practice Address - Country:US
Practice Address - Phone:817-690-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0314276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily