Provider Demographics
NPI:1659849420
Name:HARRIS, DEIRDRENEY ANDRIA (NP)
Entity Type:Individual
Prefix:
First Name:DEIRDRENEY
Middle Name:ANDRIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DEIRDRENEY
Other - Middle Name:ANDRIA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1817 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-2814
Mailing Address - Country:US
Mailing Address - Phone:580-279-0985
Mailing Address - Fax:858-461-6008
Practice Address - Street 1:1817 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-2814
Practice Address - Country:US
Practice Address - Phone:580-279-0985
Practice Address - Fax:858-461-6008
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK97710163WG0000X
AZ219768363L00000X
CA95012530363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice