Provider Demographics
NPI:1720024946
Name:HARRIS, RACHEL R (FNP- BC)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:R
Other - Last Name:SCHUBERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:PO BOX 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-8700
Mailing Address - Fax:601-582-5461
Practice Address - Street 1:222 S 27TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7165
Practice Address - Country:US
Practice Address - Phone:601-450-3030
Practice Address - Fax:601-450-3031
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR702587363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9000533OtherAETNA
MS00110358Medicaid
MS2596605OtherUNITED HEALTH CARE
MSS29073Medicare UPIN
MS302I509893Medicare PIN
MS9000533OtherAETNA