Provider Demographics
NPI:1538368659
Name:MADDEN, HARMONY M (PA-C)
Entity type:Individual
Prefix:
First Name:HARMONY
Middle Name:M
Last Name:MADDEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HARMONY
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1431 CENTERPOINT BLVD
Mailing Address - Street 2:100
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37932
Mailing Address - Country:US
Mailing Address - Phone:865-985-7049
Mailing Address - Fax:
Practice Address - Street 1:3636 HIGH STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703
Practice Address - Country:US
Practice Address - Phone:757-889-5112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002552363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10023590OtherOPTIMA
VA10023590OtherOPTIMA
VA1538368659Medicare UPIN