Provider Demographics
NPI:1366906240
Name:HARRIS, ANGELA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:GRACE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:GRACE
Other - Last Name:VICKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-932-5850
Mailing Address - Fax:540-932-5851
Practice Address - Street 1:644 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3773
Practice Address - Country:US
Practice Address - Phone:540-932-5850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110009605363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant