Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 659270 | TX |
NPI | 1083702088 |
---|---|
Provider Name | Betty M. Harris |
First Address | Huntsville, AL 35801-4537 |
Second Address | Huntsville, AL 35801-4537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 13/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
173595301 | (05) | TX |
8N8553 | BCBS (01) | TX |
P00292869 | RR MEDICARE (01) | TX |
S99304 | (02) |