Healthcare Provider Details

I. General information

NPI: 1659849420
Provider Name (Legal Business Name): DEIRDRENEY ANDRIA HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIRDRENEY ANDRIA HARRIS NP

II. Dates (important events)

Enumeration Date: 11/09/2018
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1817 ARLINGTON ST
ADA OK
74820-2814
US

IV. Provider business mailing address

1817 ARLINGTON ST
ADA OK
74820-2814
US

V. Phone/Fax

Practice location:
  • Phone: 580-279-0985
  • Fax: 858-461-6008
Mailing address:
  • Phone: 580-279-0985
  • Fax: 858-461-6008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number97710
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number219768
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: