Provider Demographics
NPI:1811027865
Name:HARRISON, BRANDICE R (PA-C)
Entity Type:Individual
Prefix:
First Name:BRANDICE
Middle Name:R
Last Name:HARRISON
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 1:3205 SUMMIT SQUARE PL STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2636
Mailing Address - Country:US
Mailing Address - Phone:859-335-9041
Mailing Address - Fax:
Practice Address - Street 1:3205 SUMMIT SQUARE PL STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2636
Practice Address - Country:US
Practice Address - Phone:859-335-9041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant