Provider Demographics
NPI:1447661566
Name:HARRELL, JEFFREY (PA)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HARRELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 E BANK ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3431
Mailing Address - Country:US
Mailing Address - Phone:804-445-6757
Mailing Address - Fax:
Practice Address - Street 1:12731 STONE VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2722
Practice Address - Country:US
Practice Address - Phone:804-579-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical