Provider Demographics
NPI:1104318849
Name:HARRIS, TEKISHA DARSHA
Entity type:Individual
Prefix:
First Name:TEKISHA
Middle Name:DARSHA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3428 CHARLESTOWNE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-4892
Mailing Address - Country:US
Mailing Address - Phone:314-304-2747
Mailing Address - Fax:
Practice Address - Street 1:415 CHEZ PAREE DR STE E
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-3599
Practice Address - Country:US
Practice Address - Phone:314-304-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No253Z00000XAgenciesIn Home Supportive Care