Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 903606 | MS |
NPI | 1265077200 |
---|---|
Provider Name | Brittany Nicole Harris |
First Address | Byram, MS 39272-4449 |
Second Address | Jackson, MS 39216-4500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2019 |
Last Update Date | 13/11/2019 |