Provider Demographics
NPI:1154389260
Name:HARRIS, PENELOPE JANE (MD)
Entity type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:JANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PENELOPE
Other - Middle Name:JANE
Other - Last Name:SCHNAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 256
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-0256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1501 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-3020
Practice Address - Country:US
Practice Address - Phone:173-267-2004
Practice Address - Fax:417-326-7201
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0439005207RH0003X
MO2016013783207RX0202X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201134520BMedicaid
MO1154389260Medicaid
KS201134520AMedicaid