Provider Demographics
NPI:1477088896
Name:HARRIS, MICHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
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 1:11603 TURTLE DR
Mailing Address - Street 2:
Mailing Address - City:STARK CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64866-8036
Mailing Address - Country:US
Mailing Address - Phone:417-850-4314
Mailing Address - Fax:
Practice Address - Street 1:11603 TURTLE DR
Practice Address - Street 2:
Practice Address - City:STARK CITY
Practice Address - State:MO
Practice Address - Zip Code:64866-8036
Practice Address - Country:US
Practice Address - Phone:417-850-4314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-23
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017006149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily