Healthcare Provider Details

I. General information

NPI: 1700733094
Provider Name (Legal Business Name): MR. RONALD LYNN HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 E 5TH ST
LUMBERTON NC
28358-6031
US

IV. Provider business mailing address

60 COMMERCE PLAZA CIR
PEMBROKE NC
28372-7386
US

V. Phone/Fax

Practice location:
  • Phone: 910-739-1666
  • Fax: 910-739-6822
Mailing address:
  • Phone: 910-521-2900
  • Fax: 910-775-9165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5024147
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: