Provider Demographics
NPI:1790135044
Name:HARRIS, TAMEKA I
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:
Last Name:HARRIS
Suffix:I
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 1:2929 HIGHWAY 33
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1628
Mailing Address - Country:US
Mailing Address - Phone:318-251-9904
Mailing Address - Fax:
Practice Address - Street 1:2929 HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-1628
Practice Address - Country:US
Practice Address - Phone:318-251-9904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant