Provider Demographics
NPI:1467857979
Name:HARRIS, JAMESIA HICKS (NP-C)
Entity Type:Individual
Prefix:
First Name:JAMESIA
Middle Name:HICKS
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP-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 850
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-0850
Mailing Address - Country:US
Mailing Address - Phone:423-272-9163
Mailing Address - Fax:423-921-6920
Practice Address - Street 1:152 HIGHWAY 143
Practice Address - Street 2:
Practice Address - City:ROAN MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37687-3002
Practice Address - Country:US
Practice Address - Phone:423-772-3276
Practice Address - Fax:423-772-4816
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN22041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily