Provider Demographics
NPI:1386137677
Name:HARRIS, KIMALA ALEISHA (DO)
Entity type:Individual
Prefix:
First Name:KIMALA
Middle Name:ALEISHA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39200 HOOKER HWY
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-5368
Mailing Address - Country:US
Mailing Address - Phone:718-772-5724
Mailing Address - Fax:
Practice Address - Street 1:941 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4353
Practice Address - Country:US
Practice Address - Phone:718-772-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine