Provider Demographics
NPI:1902318736
Name:HARRIS, OLIVIA A (MSN,RN,CPNP-PC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MSN,RN,CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 24TH ST STE 507
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1805
Mailing Address - Country:US
Mailing Address - Phone:806-743-7334
Mailing Address - Fax:806-743-7332
Practice Address - Street 1:4102 24TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410
Practice Address - Country:US
Practice Address - Phone:806-773-9509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135653363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX20173606Medicaid
TX378208803Medicaid
TX619098YKT8OtherMEDICARE
NM12281808Medicaid
TX8HT545OtherBCBS
TX1902318736OtherFIRSTCARE