Provider Demographics
NPI:1811976392
Name:HARRIS, PATTI A (CNM)
Entity type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 COOK DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3485
Mailing Address - Country:US
Mailing Address - Phone:423-745-3394
Mailing Address - Fax:423-745-3396
Practice Address - Street 1:817 COOK DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3485
Practice Address - Country:US
Practice Address - Phone:423-745-3394
Practice Address - Fax:423-745-3396
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000075866363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3660618Medicare ID - Type Unspecified