Provider Demographics
NPI:1710071683
Name:HARRIS, KELLI RANAE (ANP-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:RANAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:HONEYCUTT
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 470408
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-0408
Mailing Address - Country:US
Mailing Address - Phone:704-887-6402
Mailing Address - Fax:704-887-6450
Practice Address - Street 1:7845 LITTLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8198
Practice Address - Country:US
Practice Address - Phone:704-375-0100
Practice Address - Fax:704-887-6450
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5002288363LA2200X
NC0050-02288363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA0806340OtherNC LICENSE NUMBER
NCA0806340OtherNC LICENSE NUMBER
NC010724821OtherTIN NUMBER