Karen Jane Bandusch Harris, PA-C
Individual provider Active NPI Physician Assistant · Normal, IL
NPI 1003994104 · NPPES record last updated Jan 15, 2010
Key facts
- NPI
- 1003994104
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 085-000712 (IL)
- Practice address
- 405 Kays Drive
Normal, IL 61761 - Phone
- (309) 862-0064
- Fax
- (309) 862-1542
- NPI assigned
- Nov 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085 000712 | IL | MD | Physician Assistant |
| 085-000712 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Il Psychiatric Associates, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 085 000712 | IL | |
| Physician Assistant | 363A00000X | 085-000712 | IL | Yes |
Addresses
Primary practice location
405 Kays Drive
Normal, IL 61761
Mailing address
1400 Lismore Lane
Normal, IL 61761
Phone (309) 888-9816
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 084278 | Other | HEALTH ALLIANCE | |
| 588330 | Other | OSF HEALTH PLAN CP | |
| 5723204 | Other | BCBS | |
| 588330 | Medicaid | IL | |
| CK5970 | Other | RR MEDIC |
Other providers in Normal, IL
- Juan Fabien Baez
- Geraldine B Baird
- Dawn Baker
- Loretta Baker
- Balance Within Wellness PLLC
- Barnes Dental Associates
- Bradley William Barnes
- Danielle Basalay
- Nicholas A Bathurst
- Madison Jayann Bauer
All providers in Normal, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.