Healthcare Provider Details

I. General information

NPI: 1679544910
Provider Name (Legal Business Name): KEVIN J HARRIS C-FNP, ND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MAIN ST
WINTERSVILLE OH
43953
US

IV. Provider business mailing address

380 SUMMIT AVE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 740-314-5817
  • Fax: 740-792-4184
Mailing address:
  • Phone: 740-283-7597
  • Fax: 740-283-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.08221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: