Provider Demographics
NPI:1104315340
Name:HARRISON, KHALA CHRISTINE
Entity type:Individual
Prefix:
First Name:KHALA
Middle Name:CHRISTINE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 AMESBURY CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3832
Mailing Address - Country:US
Mailing Address - Phone:803-845-8071
Mailing Address - Fax:
Practice Address - Street 1:1912 RIDGECREST CT SE APT 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6208
Practice Address - Country:US
Practice Address - Phone:803-845-8071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant