Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 813152 | MS |
N | 363LC1500X | Nurse Practitioner - Community Health | R813152 | MS |
NPI | 1235553462 |
---|---|
Provider Name | Ms. Rebecca Harris |
First Address | Wiggins, MS 39577-9602 |
Second Address | Wiggins, MS 39577-9602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2014 |
Last Update Date | 17/01/2020 |