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NPI Code Detail

MEDICARE: MAKAYLA GABRIELLE HARR

MEDICARE: MAKAYLA GABRIELLE HARR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2152W00000XOptometrist3878TN

General Provider Information

NPI Number : 1124870803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAKAYLA GABRIELLE HARR
Provider Business Mailing Address
First Line : 2011 N ROAN ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-3130
Country : US
Telephone Number : 865-217-1010
Fax Number :
Provider Business Practice Location Address
First Line : 2011 N ROAN ST
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37601-3130
Country : US
Telephone Number : 865-217-1010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2024
Last Update Date : 06/09/2024

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Directions to “ MAKAYLA GABRIELLE HARR ” Practice Location

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