Provider Demographics
NPI:1942465745
Name:HARRIS, TESSIE TRAMAINE (FNP)
Entity Type:Individual
Prefix:
First Name:TESSIE
Middle Name:TRAMAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2213
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36702-2213
Mailing Address - Country:US
Mailing Address - Phone:334-874-7428
Mailing Address - Fax:
Practice Address - Street 1:558 COUNTY ROAD 56
Practice Address - Street 2:
Practice Address - City:VREDENBURGH
Practice Address - State:AL
Practice Address - Zip Code:36481
Practice Address - Country:US
Practice Address - Phone:334-337-4787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-100266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126816Medicaid