Provider Demographics
NPI:1295869030
Name:HARRIS-ODIMGBE, TRISHA MICHELLE (PA)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:MICHELLE
Last Name:HARRIS-ODIMGBE
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 1:9151 ESTATE THOMAS
Mailing Address - Street 2:FOOTHILLS PROF BLDG 206
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802
Mailing Address - Country:US
Mailing Address - Phone:340-779-2663
Mailing Address - Fax:340-779-2443
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:SURGERY EMERGENCY CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J6306Medicare PIN