Provider Demographics
NPI:1366302358
Name:HARRIS, KATY M (MSN, BSN, RN)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSN, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 OLDE TOWNE RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-1986
Mailing Address - Country:US
Mailing Address - Phone:757-603-4603
Mailing Address - Fax:
Practice Address - Street 1:5248 OLDE TOWNE RD STE 10
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-1986
Practice Address - Country:US
Practice Address - Phone:757-603-4603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001216294363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health