Provider Demographics
NPI:1003634536
Name:HARMON, NICOLE LYNN (PA)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:HARMON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 GLADE RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND GAP
Mailing Address - State:TN
Mailing Address - Zip Code:37724-4233
Mailing Address - Country:US
Mailing Address - Phone:618-334-2054
Mailing Address - Fax:
Practice Address - Street 1:184 GLADE RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND GAP
Practice Address - State:TN
Practice Address - Zip Code:37724-4233
Practice Address - Country:US
Practice Address - Phone:618-334-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant