Provider Demographics
NPI:1609963255
Name:HARAGUCHI, KAY (PA-C)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:
Last Name:HARAGUCHI
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 1:2801 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-6737
Mailing Address - Country:US
Mailing Address - Phone:806-293-8561
Mailing Address - Fax:806-293-8413
Practice Address - Street 1:200 S TYLER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-1448
Practice Address - Country:US
Practice Address - Phone:806-345-7917
Practice Address - Fax:806-345-7921
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01627363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197865201Medicaid
TX8J2906Medicare PIN
TXQ77497Medicare UPIN