Provider Demographics
NPI:1992065098
Name:HARRISON, JOSHUA MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:MICHAEL
Last Name:HARRISON
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 1:15500 1ST AVE S STE 106
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98148-1052
Mailing Address - Country:US
Mailing Address - Phone:206-242-0855
Mailing Address - Fax:
Practice Address - Street 1:15500 1ST AVE S STE 106
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98148-1052
Practice Address - Country:US
Practice Address - Phone:206-242-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60720367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant