Provider Demographics
NPI:1356355846
Name:HARRISON, MASON CLARKE (FNP)
Entity type:Individual
Prefix:MR
First Name:MASON
Middle Name:CLARKE
Last Name:HARRISON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5701
Mailing Address - Country:US
Mailing Address - Phone:541-226-9840
Mailing Address - Fax:541-226-9846
Practice Address - Street 1:3144 STATE ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8450
Practice Address - Country:US
Practice Address - Phone:541-226-9840
Practice Address - Fax:541-226-9846
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550153NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP01349583OtherRAILROAD MEDICARE IND
ORDU9308OtherRAILROAD MEDICARE GRP
OR026845Medicaid
ORDU9308OtherRAILROAD MEDICARE GRP
ORR173631Medicare PIN