Healthcare Provider Details

I. General information

NPI: 1811976392
Provider Name (Legal Business Name): PATTI A HARRIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COOK DR
ATHENS TN
37303-3485
US

IV. Provider business mailing address

817 COOK DR
ATHENS TN
37303-3485
US

V. Phone/Fax

Practice location:
  • Phone: 423-745-3394
  • Fax: 423-745-3396
Mailing address:
  • Phone: 423-745-3394
  • Fax: 423-745-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN0000075866
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: