Healthcare Provider Details

I. General information

NPI: 1750955282
Provider Name (Legal Business Name): LORI HARRIS CONN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 BRUNSON DR
TUPELO MS
38801-4948
US

IV. Provider business mailing address

609 BRUNSON DR
TUPELO MS
38801-4948
US

V. Phone/Fax

Practice location:
  • Phone: 662-432-1097
  • Fax:
Mailing address:
  • Phone: 662-432-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number904564
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904564
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: