Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0700X | Adult Development & Aging Psychologist |
NPI | 1881358992 |
---|---|
Provider Name | Katrina Ermayne Harris |
First Address | Wynne, AR 72396-1602 |
Second Address | Wynne, AR 72396-1602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2021 |
Last Update Date | 25/10/2021 |