Provider Demographics
NPI:1376949636
Name:HARRIS, ANNA BROOKE (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:BROOKE
Last Name:HARRIS
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 1:3513 LAKE DESIARD DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2078
Mailing Address - Country:US
Mailing Address - Phone:318-366-4379
Mailing Address - Fax:
Practice Address - Street 1:3513 LAKE DESIARD DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2078
Practice Address - Country:US
Practice Address - Phone:318-366-4379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant