Healthcare Provider Details

I. General information

NPI: 1265140032
Provider Name (Legal Business Name): CECELIA D HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECELIA WITCHER MSN, RN

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MEDI PARK DR STE 2
AMARILLO TX
79106-2105
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 806-350-7918
  • Fax: 806-418-8982
Mailing address:
  • Phone: 512-492-3743
  • Fax: 512-593-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782700
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1106480
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number80577
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: