Provider Demographics
NPI:1306920277
Name:HARRES, KARA SOPP (PA)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:SOPP
Last Name:HARRES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 LACROIX WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-2858
Mailing Address - Country:US
Mailing Address - Phone:314-210-7341
Mailing Address - Fax:
Practice Address - Street 1:625 S NEW BALLAS RD
Practice Address - Street 2:SUITE #7040
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8253
Practice Address - Country:US
Practice Address - Phone:314-251-6970
Practice Address - Fax:314-251-1053
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001771363A00000X
MO2007002748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00666818OtherRAILROAD MEDICARE
MO152470006Medicare PIN