Provider Demographics
NPI:1427017474
Name:HARRIS, TAMMY D (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:D
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:D
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 87
Mailing Address - Street 2:NEUROLOGY DEPARTMENT
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78291-0087
Mailing Address - Country:US
Mailing Address - Phone:210-358-9172
Mailing Address - Fax:210-358-9183
Practice Address - Street 1:1055 ADA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223-1703
Practice Address - Country:US
Practice Address - Phone:210-358-5515
Practice Address - Fax:210-358-5530
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197586402Medicaid
TX197586403OtherCSHCN
TX197586402Medicaid