Healthcare Provider Details

I. General information

NPI: 1932297363
Provider Name (Legal Business Name): STARLA B HARRISON APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STARLA B TICKLE

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6363 FOREST PARK #749
DALLAS TX
75390-9121
US

IV. Provider business mailing address

6363 FOREST PARK RD # 749
DALLAS TX
75235-5479
US

V. Phone/Fax

Practice location:
  • Phone: 214-645-8500
  • Fax: 214-645-3775
Mailing address:
  • Phone: 214-645-8500
  • Fax: 214-645-3775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number516979
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: