Provider Demographics
NPI:1932186475
Name:HARRIS, JAMES M JR (ARNP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:HARRIS
Suffix:JR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TSIENNETO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-1557
Mailing Address - Country:US
Mailing Address - Phone:603-552-3309
Mailing Address - Fax:603-965-4177
Practice Address - Street 1:15 TSIENNETO RD STE 200
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1557
Practice Address - Country:US
Practice Address - Phone:603-552-3309
Practice Address - Fax:603-965-4177
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH041658-23-03363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNP3889Medicare PIN
NHP66455Medicare UPIN