Healthcare Provider Details

I. General information

NPI: 1104443126
Provider Name (Legal Business Name): VERNIECEA J HARRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOONE RD
BREMERTON WA
98312-1898
US

IV. Provider business mailing address

1 BOONE RD
BREMERTON WA
98312-1898
US

V. Phone/Fax

Practice location:
  • Phone: 360-475-4379
  • Fax:
Mailing address:
  • Phone: 360-475-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD70026578
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME161530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: