| Doctor Name: | KENYETTA HARRIS |
| NPI Number: | 1730565284 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | MA057725 |
| Business Practice Address: | 132 The Meadows Dr Centre Hall, PA - 168289231 |
| Business Phone Number: | 8146342161 |
| Business Fax Number: | |
| Mailing Address: | 810 E Water St # 812, Apt:20 LOCK HAVEN |
| State: | PA |
| Postal Code: | 177451530 |
| Phone Number: | 2676291372 |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2015 |
| NPI Last Update Date: | 08/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA057725 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |