Provider Demographics
NPI:1912060278
Name:HESTER-HARRIS, DA NINE LA SHAE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:DA NINE
Middle Name:LA SHAE
Last Name:HESTER-HARRIS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:8220 WALNUT HILL LN
Mailing Address - Street 2:STE 408
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8220 WALNUT HILL LANE
Practice Address - Street 2:BUILDING 2 SUITE 408
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-361-9777
Practice Address - Fax:214-891-0084
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71002290A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200880900Medicaid
INP01678710OtherMEDICARE RAILROAD PTAN
IN266180634Medicare PIN
INM400023514Medicare PIN