Provider Demographics
NPI:1487703609
Name:HARRISON, PAULA (NP-C, CRNFA)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:NP-C, CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940387
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-0387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2145 IRONSIDE DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-3011
Practice Address - Country:US
Practice Address - Phone:214-794-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX051658163WR0006X
TXA0608097363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX051658OtherPERIOPERATIVE NURSING
TXA0608097OtherNURSE PRACTITIONER
TX534198OtherBOARD OF NURSE EXAMINERS
TX613416Medicare PIN