Provider Demographics
NPI:1104458751
Name:HARRIS, KASHONDRA DENAE (FNP)
Entity type:Individual
Prefix:
First Name:KASHONDRA
Middle Name:DENAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GRAFTON ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3824
Mailing Address - Country:US
Mailing Address - Phone:478-719-2286
Mailing Address - Fax:
Practice Address - Street 1:2782 N COBB PKWY
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3472
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP70014578207Q00000X
VA0024188994207Q00000X
NC5022496207Q00000X
COAPN0102926-C-NP207Q00000X
OH0038608207Q00000X
IAA185201207Q00000X
TX1176309207Q00000X
NJ26NJ15421300207Q00000X
FLAPRN11030058207Q00000X
TN40023207Q00000X
GARN220216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine