Active NPI
Timothy Noble Harkins, MS, PA-C, ATC
- Physician Assistant
- Henderson, NV
National Provider Identifier
1417371949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA2175
- Practice address
- 1475 Raiders Way
Henderson, NV 89052-4604 - Phone
- (725) 780-3406
- Fax
- (725) 780-3540
- NPI assigned
- Feb 4, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA56353 | CA | |
| Physician Assistant | 363A00000X | PA2175 | NV | Primary |
Addresses
Primary practice location
1475 Raiders Way
Henderson, NV 89052-4604
Mailing address
1235 Diamond Valley St
Henderson, NV 89052-3019
Phone (510) 305-2991
Other practice location 1
1220 Harbor Bay Pkwy
Alameda, CA 94502-6501
Phone (510) 864-5000
Other practice location 2
3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone (310) 900-8900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E1667548 | Other | CA | DRIVERS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56353 | CA | MD | General Practice Dentistry |
| PA56353 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618099200000",
"number": "1417371949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1235 DIAMOND VALLEY ST",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890523019",
"telephone_number": "510-305-2991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1475 RAIDERS WAY",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890524604",
"telephone_number": "725-780-3406",
"fax_number": "725-780-3540"
}
],
"practiceLocations": [
{
"address_1": "1220 Harbor Bay Pkwy",
"address_purpose": "LOCATION",
"city": "Alameda",
"state": "CA",
"postal_code": "945026501",
"country_code": "US",
"telephone_number": "510-864-5000",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3630 E Imperial Hwy",
"address_purpose": "LOCATION",
"city": "Lynwood",
"state": "CA",
"postal_code": "902622609",
"country_code": "US",
"telephone_number": "310-900-8900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HARKINS",
"first_name": "TIMOTHY",
"middle_name": "NOBLE",
"name_prefix": "Mr.",
"credential": "MS, PA-C, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-04",
"last_updated": "2021-04-11",
"certification_date": "2021-04-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA56353",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA2175",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DRIVERS LICENSE",
"identifier": "E1667548",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.