Harris, Derek R.

Harris, Derek R. is an individual health care provider with primary practice located at 1919 Fairfield Ave , Shreveport LA 71101-4436. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as his primary health care specialty. Harris, Derek R. can be contacted via phone (318) 828-2210.

Contact Information

Primary practice address
1919 Fairfield Ave Shreveport LA 71101-4436
Phone: (318) 828-2210
Fax: (318) 828-2215
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X AP07181 Louisiana

Profile Details

NPI number 1821360728
LBN Legal business name Harris, Derek R.
Credentials MSN, APRN, CPNP-PC
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 8th, 2012
Last updated Jun 17th, 2019 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821360728 NPPES
Louisiana MEDICAID 2330578

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