Provider Demographics
NPI:1619402195
Name:HARRIS, KEYA S
Entity Type:Individual
Prefix:
First Name:KEYA
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 ACCENT DR APT 1932
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-7715
Mailing Address - Country:US
Mailing Address - Phone:213-327-5595
Mailing Address - Fax:
Practice Address - Street 1:3930 ACCENT DR APT 1932
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-7715
Practice Address - Country:US
Practice Address - Phone:213-327-5595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No374700000XNursing Service Related ProvidersTechnician
No374U00000XNursing Service Related ProvidersHome Health Aide