Provider Demographics
NPI:1497460562
Name:HARRIS, ALAN KEITH I
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:KEITH
Last Name:HARRIS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8034 GILMER BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-5348
Mailing Address - Country:US
Mailing Address - Phone:318-404-8425
Mailing Address - Fax:
Practice Address - Street 1:8034 GILMER BAYOU LN
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-5348
Practice Address - Country:US
Practice Address - Phone:318-404-8425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator