Provider Demographics
NPI:1346478252
Name:HARWELL, DELORIS RENEE (PNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:DELORIS
Middle Name:RENEE
Last Name:HARWELL
Suffix:
Gender:F
Credentials:PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E US HIGHWAY 80 STE 190
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8615
Mailing Address - Country:US
Mailing Address - Phone:469-602-5277
Mailing Address - Fax:844-881-1772
Practice Address - Street 1:104 E US HIGHWAY 80 STE 190
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126
Practice Address - Country:US
Practice Address - Phone:469-602-5277
Practice Address - Fax:469-995-7898
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117846363L00000X
TX703123363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1346478252Medicaid
TX203992707Medicaid
TX203992701Medicaid
TX203992703Medicaid
TX203992703Medicaid
TX8L16119Medicare PIN