Provider Demographics
NPI:1659843712
Name:HARP, COREY (PA-C)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:HARP
Suffix:
Gender:M
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 1:5350 N 199TH ST W
Mailing Address - Street 2:
Mailing Address - City:COLWICH
Mailing Address - State:KS
Mailing Address - Zip Code:67030-9621
Mailing Address - Country:US
Mailing Address - Phone:316-734-0321
Mailing Address - Fax:
Practice Address - Street 1:520 S SANTA FE AVE STE 240
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-452-7366
Practice Address - Fax:785-452-7354
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02188363AM0700X, 363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201234100AMedicaid