Basic Information
| Provider Information | |||||||||
| NPI: | 1013487867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRELSON | ||||||||
| FirstName: | PAIGE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5220 W UNIVERSITY DR | ||||||||
| Address2: | STE 150 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729841050 | ||||||||
| FaxNumber: | 9729841376 | ||||||||
| Practice Location | |||||||||
| Address1: | 5220 W UNIVERSITY DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9729841050 | ||||||||
| FaxNumber: | 9729841376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2018 | ||||||||
| LastUpdateDate: | 12/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA12438 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 207Y00000X | PA12438 | TX | N | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.