Provider Demographics
NPI:1093339442
Name:HARRIS, KAITLYN COLLEEN (BS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:COLLEEN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N J ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-2236
Mailing Address - Country:US
Mailing Address - Phone:580-317-6850
Mailing Address - Fax:
Practice Address - Street 1:1212 E KIRK ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-3607
Practice Address - Country:US
Practice Address - Phone:580-326-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator