Provider Demographics
NPI:1316653702
Name:HARRISON, KYRA LOREEN (PA)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:LOREEN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1718 N LAS PALMAS AVE APT 234
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-3815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11650 RIVERSIDE DR STE 11
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1095
Practice Address - Country:US
Practice Address - Phone:310-954-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-02-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant