Provider Demographics
NPI:1073894994
Name:HARRIS, KEITH DANIEL (PA-C)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:DANIEL
Last Name:HARRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 SCOTT LOOP
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3217
Mailing Address - Country:US
Mailing Address - Phone:304-707-1358
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 683 WAIANAE AVE
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96876
Practice Address - Country:US
Practice Address - Phone:888-683-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical