Provider Demographics
NPI:1528641271
Name:HARRIS, TERESSA LYNE (RN CCM -HEALTH COACH)
Entity type:Individual
Prefix:
First Name:TERESSA
Middle Name:LYNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN CCM -HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 111TH ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6764
Mailing Address - Country:US
Mailing Address - Phone:180-620-1571
Mailing Address - Fax:
Practice Address - Street 1:2504 111TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-6764
Practice Address - Country:US
Practice Address - Phone:180-620-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX989316163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty