Provider Demographics
NPI:1821671082
Name:HARRIS, KASHAYLA (FNP)
Entity Type:Individual
Prefix:
First Name:KASHAYLA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KASHAYLA
Other - Middle Name:
Other - Last Name:MOLDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7927 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4406
Mailing Address - Country:US
Mailing Address - Phone:901-286-0166
Mailing Address - Fax:
Practice Address - Street 1:7927 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4406
Practice Address - Country:US
Practice Address - Phone:901-286-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904526363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily