Healthcare Provider Details

I. General information

NPI: 1104417799
Provider Name (Legal Business Name): PAULA GLOVER HARRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 07/15/2024
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 MEDICAL PARK RD STE 140A
MOORESVILLE NC
28117-8540
US

IV. Provider business mailing address

PO BOX 19305
CHARLOTTE NC
28219-9305
US

V. Phone/Fax

Practice location:
  • Phone: 704-663-4443
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5014762
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5014762
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: