Healthcare Provider Details

I. General information

NPI: 1154389260
Provider Name (Legal Business Name): PENELOPE JANE HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PENELOPE JANE SCHNAKE MD

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 N OAKLAND AVE
BOLIVAR MO
65613-3020
US

IV. Provider business mailing address

PO BOX 256
SALINA KS
67402-0256
US

V. Phone/Fax

Practice location:
  • Phone: 173-267-2004
  • Fax: 417-326-7201
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0439005
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2016013783
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2016013783
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: