Healthcare Provider Details

I. General information

NPI: 1598077042
Provider Name (Legal Business Name): KARYN J HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 N JACKSON ST
TULLAHOMA TN
37388-2343
US

IV. Provider business mailing address

1511 N JACKSON ST
TULLAHOMA TN
37388-2343
US

V. Phone/Fax

Practice location:
  • Phone: 931-507-1212
  • Fax:
Mailing address:
  • Phone: 931-507-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15031
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: