Healthcare Provider Details

I. General information

NPI: 1962368100
Provider Name (Legal Business Name): FARHAN HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 DAISY ST
BASTROP LA
71220-0000
US

IV. Provider business mailing address

1004 CHARLIE AVE
BASTROP LA
71220-5911
US

V. Phone/Fax

Practice location:
  • Phone: 318-953-7590
  • Fax:
Mailing address:
  • Phone: 318-953-7590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: