Healthcare Provider Details

I. General information

NPI: 1760919187
Provider Name (Legal Business Name): KIMBERLY STEPHENIA HARRIS FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 11/25/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 704-939-1100
  • Fax: 704-939-1173
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-983-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number270275
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5009565
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5009565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: