Provider Demographics
NPI:1609802586
Name:HARNESS, KAREN LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LEIGH
Last Name:HARNESS
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 1:5925 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-3458
Mailing Address - Country:US
Mailing Address - Phone:205-681-0079
Mailing Address - Fax:
Practice Address - Street 1:5925 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-3458
Practice Address - Country:US
Practice Address - Phone:205-681-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-123363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009934249Medicaid
AL051529443OtherBLUE CROSS
AL051529442OtherBLUE CROSS
AL891009960Medicaid
AL051529441OtherBLUE CROSS
AL009932158Medicaid
AL009934249Medicaid
AL009932158Medicaid