Provider Demographics
NPI:1538545272
Name:HARRIS, MILES (FNP-BC)
Entity type:Individual
Prefix:
First Name:MILES
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-5216
Mailing Address - Country:US
Mailing Address - Phone:916-443-3299
Mailing Address - Fax:916-325-1980
Practice Address - Street 1:1500 21ST ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5216
Practice Address - Country:US
Practice Address - Phone:916-443-3299
Practice Address - Fax:916-325-1980
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339876363LF0000X
CA95009050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
NY331954Medicare Oscar/Certification
NY331058Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY00695941Medicaid
NY331043Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331978Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NYW6L111Medicare Oscar/Certification
NYG100000410Medicare Oscar/Certification