Healthcare Provider Details

I. General information

NPI: 1396996047
Provider Name (Legal Business Name): CAROL LYNN HARRISS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 09/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620THOUSAND OAKS BLVD SUITE 2400
MEMPHIS TN
38118
US

IV. Provider business mailing address

7234 DEVINE ST
BARTLETT TN
38133-3933
US

V. Phone/Fax

Practice location:
  • Phone: 901-566-3310
  • Fax:
Mailing address:
  • Phone: 901-949-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number035080
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number035080
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: