Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | J6479 | TX |
N | 207VG0400X | Gynecologist | J6479 | TX |
N | 207VX0000X | Obstetrician | J6479 | TX |
NPI | 1336159128 |
---|---|
Provider Name | Amanda L Harris |
First Address | Tyler, TX 75701-1952 |
Second Address | Tyler, TX 75701-1952 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 16/01/2019 |