Provider Demographics
NPI:1992075162
Name:HARRIS, KANTRELL RAISHANDA (PA- C)
Entity type:Individual
Prefix:
First Name:KANTRELL
Middle Name:RAISHANDA
Last Name:HARRIS
Suffix:
Gender:F
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 1:6550 FANNIN ST STE 1401
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2738
Mailing Address - Country:US
Mailing Address - Phone:713-441-5200
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST STE 1401
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2738
Practice Address - Country:US
Practice Address - Phone:713-441-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical