Healthcare Provider Details

I. General information

NPI: 1972411478
Provider Name (Legal Business Name): HARRIS HEALTH COLLECTIVE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5357 CLIFF GOOKIN BLVD
TUPELO MS
38801-7085
US

IV. Provider business mailing address

60 PERRY RD
WEST POINT MS
39773-4886
US

V. Phone/Fax

Practice location:
  • Phone: 662-871-1573
  • Fax:
Mailing address:
  • Phone: 662-295-6936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EBONY HARRIS
Title or Position: OWNER/PROVIDER
Credential: FNP-BC
Phone: 662-295-6936