Provider Demographics
NPI:1366452609
Name:HARRISON, JUSTIN LADELL (PA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LADELL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1633 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-3033
Mailing Address - Country:US
Mailing Address - Phone:325-672-4372
Mailing Address - Fax:325-673-0856
Practice Address - Street 1:1633 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-3033
Practice Address - Country:US
Practice Address - Phone:325-672-4372
Practice Address - Fax:325-673-0856
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-07-20
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant