Provider Demographics
NPI:1154803005
Name:HARRIS, ARETHA RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:ARETHA
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-2318
Mailing Address - Country:US
Mailing Address - Phone:662-631-4316
Mailing Address - Fax:406-315-7338
Practice Address - Street 1:403 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2318
Practice Address - Country:US
Practice Address - Phone:662-631-4316
Practice Address - Fax:406-315-7338
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902497363L00000X, 363L00000X
IAA152322363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner