Provider Demographics
NPI:1801807136
Name:HARRIS, CARLA DIANE (CERTIFIED NURSE PRAC)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:DIANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CERTIFIED NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CORSICANA CROSSINGS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-9302
Mailing Address - Country:US
Mailing Address - Phone:903-872-6065
Mailing Address - Fax:903-872-2975
Practice Address - Street 1:3201 CORSICANA CROSSINGS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-9302
Practice Address - Country:US
Practice Address - Phone:903-872-6065
Practice Address - Fax:903-872-2975
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR59688363LF0000X
TXAP112068363LP2300X
TX037611322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM27906728Medicaid
TX8F001Medicare ID - Type Unspecified