Provider Demographics
NPI:1881787349
Name:HARKER, MARYANNE E (PA-C)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:E
Last Name:HARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARYANNE
Other - Middle Name:
Other - Last Name:HARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:10505 WATERVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8485
Mailing Address - Country:US
Mailing Address - Phone:214-570-9400
Mailing Address - Fax:855-663-2688
Practice Address - Street 1:1260 W SPRING VALLEY RD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-6720
Practice Address - Country:US
Practice Address - Phone:214-570-9400
Practice Address - Fax:855-663-2688
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05315363A00000X
CAPA17778363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical