Provider Demographics
NPI:1336938653
Name:HARRIS, LORETTA JEWEL
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:JEWEL
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N 73RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-7843
Mailing Address - Country:US
Mailing Address - Phone:316-794-0406
Mailing Address - Fax:
Practice Address - Street 1:704 N 73RD EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-7843
Practice Address - Country:US
Practice Address - Phone:316-794-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000000000175T00000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist