Provider Demographics
NPI:1043918360
Name:HARRIS, TYRONE K
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:K
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12074 ROCKWELL ROAD
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:43143
Mailing Address - Country:US
Mailing Address - Phone:740-296-0095
Mailing Address - Fax:
Practice Address - Street 1:330 W MAIN ST APT D
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:OH
Practice Address - Zip Code:43143-1264
Practice Address - Country:US
Practice Address - Phone:740-296-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health