Provider Demographics
NPI:1386332716
Name:HARRIS, KATHARINA LYNN (NP)
Entity type:Individual
Prefix:
First Name:KATHARINA
Middle Name:LYNN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KATHARINA
Other - Middle Name:LYNN
Other - Last Name:STAATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2920 S MCINTIRE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4221
Mailing Address - Country:US
Mailing Address - Phone:765-349-6793
Mailing Address - Fax:765-349-6949
Practice Address - Street 1:2920 S MCINTIRE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4221
Practice Address - Country:US
Practice Address - Phone:765-349-6793
Practice Address - Fax:765-349-6949
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013753A363LF0000X
IN28226012A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse