Provider Demographics
NPI:1427282599
Name:HARRIS, TONI T (CPNP-AC)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:T
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 POPLAR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-4625
Mailing Address - Country:US
Mailing Address - Phone:601-668-1236
Mailing Address - Fax:
Practice Address - Street 1:1523 22ND AVE STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-703-8370
Practice Address - Fax:601-703-8397
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR851046363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL189936Medicaid
MS07100010Medicaid
MS302I509852Medicare PIN