Healthcare Provider Details

I. General information

NPI: 1801672274
Provider Name (Legal Business Name): KC HARRISON BSN, RN, MS, CSP-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 LOCKETT PL
MEMPHIS TN
38104-3923
US

IV. Provider business mailing address

1713 LOCKETT PL
MEMPHIS TN
38104-3923
US

V. Phone/Fax

Practice location:
  • Phone: 901-372-0710
  • Fax:
Mailing address:
  • Phone: 901-372-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number139928
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: