Provider Demographics
NPI:1184111098
Name:HARRIS, CHIQUITA LETITIDA
Entity type:Individual
Prefix:MRS
First Name:CHIQUITA
Middle Name:LETITIDA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHIQUITA
Other - Middle Name:LETITIDA
Other - Last Name:BICKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1613 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8536
Mailing Address - Country:US
Mailing Address - Phone:940-488-5105
Mailing Address - Fax:940-488-5105
Practice Address - Street 1:1613 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-8536
Practice Address - Country:US
Practice Address - Phone:940-488-5105
Practice Address - Fax:940-488-5105
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty