Provider Demographics
NPI:1740916808
Name:HARRIS, BONNIE (FNP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WILDCAT DR STE C
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-2826
Mailing Address - Country:US
Mailing Address - Phone:361-643-9800
Mailing Address - Fax:361-643-5112
Practice Address - Street 1:1500 WILDCAT DR STE C
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2826
Practice Address - Country:US
Practice Address - Phone:361-643-9800
Practice Address - Fax:361-643-5112
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1088590363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics