Provider Demographics
NPI:1801847975
Name:HARRIS, LISA M (PAC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 N RIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1571
Mailing Address - Country:US
Mailing Address - Phone:316-648-1157
Mailing Address - Fax:316-440-6601
Practice Address - Street 1:2131 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1570
Practice Address - Country:US
Practice Address - Phone:316-773-1212
Practice Address - Fax:316-729-1385
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1500851363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100424600CMedicaid
KS426809OtherBCBS
KS426809Medicare ID - Type Unspecified
KS100424600CMedicaid