Provider Demographics
NPI:1326494386
Name:HARRAH, MARY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:HARRAH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:812-689-3424
Mailing Address - Fax:812-933-5237
Practice Address - Street 1:112 N BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:OSGOOD
Practice Address - State:IN
Practice Address - Zip Code:47037-1134
Practice Address - Country:US
Practice Address - Phone:812-689-3424
Practice Address - Fax:812-933-5237
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006348A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201371400Medicaid