Provider Demographics
NPI:1245720838
Name:HARRIS, KELLI D'ANN (MSN, RN, AGACNP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:D'ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:808 JOLIET AVE UNIT 220
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415
Practice Address - Country:US
Practice Address - Phone:806-761-0566
Practice Address - Fax:806-744-7252
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP137001363L00000X
TX742224163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse