Charles F Harris, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

76 Issued in WY

Practice address

982 W. Broadway
Jackson, WY 83002

Phone

(307) 733-8002

Fax

(307) 733-0032

NPI assigned

Jan 29, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Grand Teton Medical Clinic

  • Urgent Care Clinic/Center
  • Moran, WY
  • NPI 1891997151
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1386780237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15240",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830025240",
            "telephone_number": "307-733-8002",
            "fax_number": "307-733-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "982 W. BROADWAY",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83002",
            "telephone_number": "307-733-8002",
            "fax_number": "307-733-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "CHARLES",
        "middle_name": "F",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-29",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WY",
            "license": "76",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WY",
            "license": "76",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109651600",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jean Ann Hamilton, CRNA
• William David Hamilton, CRNA
• Tayler Hancock
• Blake G Hansen, LCSW
• Jacquelin Foss Hardenbrook, M.D.
• Jacqueline Hart
• Judith Anne Harvey, LPN
• Debra Ann Hathcock
• Rebecca M Hawkins, PT
• George Douglas Hayden III, DPT

• Medical Physician Assistant in Jackson, WY
• Providers in Jackson, WY by specialty
• Medical Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.