Provider Demographics
NPI:1760473060
Name:HARRINGTON, KERRY LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:LYN
Last Name:HARRINGTON
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 1:1292 HIGH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3238
Mailing Address - Country:US
Mailing Address - Phone:541-500-2500
Mailing Address - Fax:
Practice Address - Street 1:1740 NW GOETZ ST
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-1613
Practice Address - Country:US
Practice Address - Phone:541-640-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01176363A00000X
CAPA16258207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA162580Medicaid
CAOPA162580Medicaid
P69914Medicare UPIN
136970Medicare PIN