Provider Demographics
NPI:1659246833
Name:HARRIS, STEPHANIE NICOLE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE
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 1:5439 LEXIE ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-9010
Mailing Address - Country:US
Mailing Address - Phone:901-491-9132
Mailing Address - Fax:901-205-0505
Practice Address - Street 1:5439 LEXIE ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-9010
Practice Address - Country:US
Practice Address - Phone:901-491-9132
Practice Address - Fax:901-205-0505
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN198773376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty