Healthcare Provider Details

I. General information

NPI: 1265140032
Provider Name (Legal Business Name): CECELIA D HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECELIA WITCHER MSN, RN

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE SE
ALBUQUERQUE NM
87106-4930
US

IV. Provider business mailing address

PO BOX 26666 PHS PROVIDER ENROLLMENT
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-559-1000
  • Fax: 505-724-8995
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782700
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80577
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1106480
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: