Healthcare Provider Details

I. General information

NPI: 1083697262
Provider Name (Legal Business Name): CAROLYN K HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 LANDOVER PL
LYNCHBURG VA
24501-2115
US

IV. Provider business mailing address

PO BOX 11889
LYNCHBURG VA
24506-1889
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3944
  • Fax: 434-544-2316
Mailing address:
  • Phone: 434-947-3944
  • Fax: 434-544-2316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0017000378
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: