Provider Demographics
NPI:1952366957
Name:HARRIS, DANA R (ARNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:R
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1008
Mailing Address - Country:US
Mailing Address - Phone:502-775-1211
Mailing Address - Fax:502-443-9391
Practice Address - Street 1:2406 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1008
Practice Address - Country:US
Practice Address - Phone:502-775-1211
Practice Address - Fax:502-443-9391
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2334P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78004181Medicaid
KY50009784OtherPASSPORT- NORTON
KY000052155JOtherHUMANA- NORTON
KY000000350660OtherANTHEM- NORTON
KY1193985OtherCHA- NORTON
KY2690098000OtherPASSPORT ADVN-NORTON
KYP00193681OtherRAILROAD MEDICARE
KY009696OtherSIHO- NORTON
KY0361933Medicare PIN
KY009696OtherSIHO- NORTON