Healthcare Provider Details

I. General information

NPI: 1548057615
Provider Name (Legal Business Name): NIKITA SHAURICE HARRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 HARDY ST
HATTIESBURG MS
39402-1308
US

IV. Provider business mailing address

700 BEVERLY HILLS RD APT 428
HATTIESBURG MS
39401-4499
US

V. Phone/Fax

Practice location:
  • Phone: 601-268-8000
  • Fax:
Mailing address:
  • Phone: 662-299-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number919381
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: