Provider Demographics
NPI:1932983871
Name:HARRIS, MARKAYNE LACY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:MARKAYNE
Middle Name:LACY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 GEORGIA CT N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2529
Mailing Address - Country:US
Mailing Address - Phone:763-647-9173
Mailing Address - Fax:
Practice Address - Street 1:8125 GEORGIA CT N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2529
Practice Address - Country:US
Practice Address - Phone:763-647-9173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2485919363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health