Provider Demographics
NPI:1083662969
Name:HARRIS, GINA L (APRN)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:404 N KEENE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6626
Practice Address - Country:US
Practice Address - Phone:573-499-6084
Practice Address - Fax:573-499-6088
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN091360363L00000X
MO091360363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO425202207Medicaid
MO132709OtherBLUE SHIELD/BLUE CHOICE
KS4287218101OtherKANSAS MEDICAID
MO446031OtherHEALTHLINK
MO890000729OtherRR MEDICARE
KS4287218101OtherKANSAS MEDICAID
MO132709OtherBLUE SHIELD/BLUE CHOICE
MO834005236Medicare PIN