Provider Demographics
NPI:1497802516
Name:HARRIS, CONSUELA DENISE (DNP)
Entity Type:Individual
Prefix:
First Name:CONSUELA
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:CONSUELA
Other - Middle Name:DENISE
Other - Last Name:WITHERSPOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP/FNP-BC
Mailing Address - Street 1:2800 EAST TEXAS HIGHWAY 114
Mailing Address - Street 2:STE 350
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5033
Mailing Address - Country:US
Mailing Address - Phone:817-674-7983
Mailing Address - Fax:
Practice Address - Street 1:2800 EAST TEXAS HIGHWAY 114
Practice Address - Street 2:STE 350
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5033
Practice Address - Country:US
Practice Address - Phone:817-674-7983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115509363LP0808X, 363L00000X
TX682737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX682737OtherSTATE LICENSE