Provider Demographics
NPI:1417371949
Name:HARKINS, TIMOTHY NOBLE (MS, PA-C, ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:NOBLE
Last Name:HARKINS
Suffix:
Gender:M
Credentials:MS, PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 DIAMOND VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3019
Mailing Address - Country:US
Mailing Address - Phone:510-305-2991
Mailing Address - Fax:
Practice Address - Street 1:1475 RAIDERS WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4604
Practice Address - Country:US
Practice Address - Phone:725-780-3406
Practice Address - Fax:725-780-3540
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA56353363A00000X
NVPA2175363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1667548OtherDRIVERS LICENSE