Provider Demographics
NPI:1558662411
Name:HARRIS, CHARLY EMERSON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHARLY
Middle Name:EMERSON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 PINEY FOREST RD STE E
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4154
Mailing Address - Country:US
Mailing Address - Phone:434-791-4110
Mailing Address - Fax:434-791-4003
Practice Address - Street 1:441 PINEY FOREST RD STE E
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4154
Practice Address - Country:US
Practice Address - Phone:434-791-4110
Practice Address - Fax:434-791-4003
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily