Provider Demographics
NPI:1437728789
Name:HARRIS, PAMELA MICHELLE (RD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 STEINER BLVD
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1009
Mailing Address - Country:US
Mailing Address - Phone:304-617-1769
Mailing Address - Fax:
Practice Address - Street 1:3 STEINER BLVD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1009
Practice Address - Country:US
Practice Address - Phone:304-617-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV718133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered