Provider Demographics
NPI:1639450356
Name:HARSH, KEVIN RAY (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:RAY
Last Name:HARSH
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 LACEY AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2039
Mailing Address - Country:US
Mailing Address - Phone:719-384-0303
Mailing Address - Fax:719-384-0205
Practice Address - Street 1:318 LACEY AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-2039
Practice Address - Country:US
Practice Address - Phone:719-384-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO990187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily