Provider Demographics
NPI:1952774143
Name:HARRIS, REBECCA H (AGNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:H
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:BLAKE
Other - Last Name:HARBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-635-3906
Mailing Address - Fax:252-224-0378
Practice Address - Street 1:4252 ARENDELL ST STE E
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-0015
Practice Address - Country:US
Practice Address - Phone:252-808-0145
Practice Address - Fax:252-808-2770
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008203363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner