Provider Demographics
NPI:1932297363
Name:HARRISON, STARLA B (APRN, BC)
Entity Type:Individual
Prefix:
First Name:STARLA
Middle Name:B
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:STARLA
Other - Middle Name:B
Other - Last Name:TICKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6363 FOREST PARK RD # 749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5479
Mailing Address - Country:US
Mailing Address - Phone:214-645-8500
Mailing Address - Fax:214-645-3775
Practice Address - Street 1:6363 FOREST PARK
Practice Address - Street 2:#749
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9121
Practice Address - Country:US
Practice Address - Phone:214-645-8500
Practice Address - Fax:214-645-3775
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX516979364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044398801Medicaid
TX85N507Medicare ID - Type Unspecified