Provider Demographics
NPI:1669884243
Name:HARRIS, JUDY A (ACNP)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:ANN
Other - Last Name:LARUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 ROSA RD
Mailing Address - Street 2:SUITE 382
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308
Mailing Address - Country:US
Mailing Address - Phone:518-386-3691
Mailing Address - Fax:518-386-3553
Practice Address - Street 1:124 ROSA RD
Practice Address - Street 2:SUITE 382
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308
Practice Address - Country:US
Practice Address - Phone:518-386-3691
Practice Address - Fax:518-386-3557
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430803363LA2100X
NY430803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner