Provider Demographics
NPI:1912948555
Name:HARRISON, LUTRICIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LUTRICIA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 NORTH SAM HOUSTON PARKWAY EAST
Mailing Address - Street 2:SUITE H
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060
Mailing Address - Country:US
Mailing Address - Phone:281-260-6622
Mailing Address - Fax:281-260-6688
Practice Address - Street 1:412 N SAM HOUSTON PKWY E
Practice Address - Street 2:SUITE H
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3508
Practice Address - Country:US
Practice Address - Phone:281-260-6622
Practice Address - Fax:281-260-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX620452363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183321201Medicaid
TX2698846OtherUNITED HEALTHCARE
TX620452OtherFNP
TX01165509OtherAMERIGROUP
TX183321202OtherTEXAS HEALTH STEPS
NP7239OtherBLUE CROSS BLUE SHIELD
TX01165509OtherAMERIGROUP
TX620452OtherFNP