Provider Demographics
NPI:1235553462
Name:HARRIS, REBECCA (FNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
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 1:1440 CENTRAL AVE E
Mailing Address - Street 2:
Mailing Address - City:WIGGINS
Mailing Address - State:MS
Mailing Address - Zip Code:39577-9602
Mailing Address - Country:US
Mailing Address - Phone:601-928-6700
Mailing Address - Fax:601-928-6731
Practice Address - Street 1:1440 CENTRAL AVE E
Practice Address - Street 2:
Practice Address - City:WIGGINS
Practice Address - State:MS
Practice Address - Zip Code:39577-9602
Practice Address - Country:US
Practice Address - Phone:601-928-6700
Practice Address - Fax:601-928-6731
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR813152363LC1500X
MS813152363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health