Healthcare Provider Details

I. General information

NPI: 1417488438
Provider Name (Legal Business Name): ELIZABETH HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 EASTERN BYP STE 14
RICHMOND KY
40475-2400
US

IV. Provider business mailing address

789 EASTERN BYP STE 14
RICHMOND KY
40475-2400
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-0900
  • Fax: 859-625-0995
Mailing address:
  • Phone: 859-625-0900
  • Fax: 859-625-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberTP965
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number57224
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberS5646
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: