Healthcare Provider Details

I. General information

NPI: 1992156863
Provider Name (Legal Business Name): BRITTANY KELLY HARRIS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W SERVICE DR
COLDWATER MS
38618-3822
US

IV. Provider business mailing address

510 HIGHWAY 322
CLARKSDALE MS
38614-4717
US

V. Phone/Fax

Practice location:
  • Phone: 662-233-5200
  • Fax: 662-233-5200
Mailing address:
  • Phone: 662-624-4292
  • Fax: 662-351-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24169
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMS901594
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: