Provider Demographics
NPI:1306026190
Name:HARRIS, DARREL ALAN (RN)
Entity Type:Individual
Prefix:
First Name:DARREL
Middle Name:ALAN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 PEQUENO LN
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3673
Mailing Address - Country:US
Mailing Address - Phone:636-861-7633
Mailing Address - Fax:636-861-7633
Practice Address - Street 1:1206 PEQUENO LN
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-3673
Practice Address - Country:US
Practice Address - Phone:636-861-7633
Practice Address - Fax:636-861-7633
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO124205163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult