Healthcare Provider Details

I. General information

NPI: 1033558861
Provider Name (Legal Business Name): KIMBERLY A HARRIS CPNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 BELAIRE CT
HIAWASSEE GA
30546
US

IV. Provider business mailing address

225 MARKET PLACE CONNECTOR # 1192
PEACHTREE CITY GA
30269-3542
US

V. Phone/Fax

Practice location:
  • Phone: 470-317-4405
  • Fax: 866-560-9778
Mailing address:
  • Phone: 470-317-4405
  • Fax: 866-560-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN171399
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN171399
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: