Provider Demographics
NPI:1982034476
Name:HARRIS 4 HEALTH
Entity Type:Organization
Organization Name:HARRIS 4 HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM, FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:RANEE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CNM, FNP-C
Authorized Official - Phone:972-304-6400
Mailing Address - Street 1:420 W BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4401
Mailing Address - Country:US
Mailing Address - Phone:972-304-6400
Mailing Address - Fax:972-304-6455
Practice Address - Street 1:420 W BETHEL RD
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4401
Practice Address - Country:US
Practice Address - Phone:972-304-6400
Practice Address - Fax:972-304-6455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX625586363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407912827OtherTYPE 1 NPI