Provider Demographics
NPI:1083702088
Name:HARRIS, BETTY M (RN, WHNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 102
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-251-5121
Mailing Address - Fax:256-513-4969
Practice Address - Street 1:2006 FRANKLIN ST SE STE 102
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-251-5121
Practice Address - Fax:256-513-4969
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659270363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00292869OtherRR MEDICARE
TX173595301Medicaid
TX8N8553OtherBCBS
S99304Medicare UPIN
TX8D5357Medicare PIN