Provider Demographics
NPI:1396996047
Name:HARRISS, CAROL LYNN (RN)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:HARRISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7234 DEVINE ST
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-3933
Mailing Address - Country:US
Mailing Address - Phone:901-949-8649
Mailing Address - Fax:
Practice Address - Street 1:2620THOUSAND OAKS BLVD
Practice Address - Street 2:SUITE 2400
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118
Practice Address - Country:US
Practice Address - Phone:901-566-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN035080163WC0400X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health