Provider Demographics
NPI:1033115332
Name:HARRIS, KATHI L (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHI
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:KATHI
Other - Middle Name:L
Other - Last Name:CONNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:370 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1789
Mailing Address - Country:US
Mailing Address - Phone:740-367-6028
Mailing Address - Fax:740-696-2852
Practice Address - Street 1:370 28TH ST
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1789
Practice Address - Country:US
Practice Address - Phone:740-676-2819
Practice Address - Fax:740-696-2852
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV38440363LF0000X
OH05497363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7101223000Medicaid
OH2432193Medicaid
WV7101223000Medicaid
WV7101223000Medicaid