Provider Demographics
NPI:1083050223
Name:HARRIS, PAMELA SMITH (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SMITH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2143 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-1239
Mailing Address - Country:US
Mailing Address - Phone:225-246-8136
Mailing Address - Fax:
Practice Address - Street 1:2143 PALISADES DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-1239
Practice Address - Country:US
Practice Address - Phone:225-246-8136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN100370163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse