Healthcare Provider Details

I. General information

NPI: 1023971256
Provider Name (Legal Business Name): LARNELL HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 FREDERICK ST
BLUEFIELD WV
24701-3942
US

IV. Provider business mailing address

1027 FREDERICK ST
BLUEFIELD WV
24701-3942
US

V. Phone/Fax

Practice location:
  • Phone: 304-327-5305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: