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General NPI Number Information
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NPI Number | 1306349550
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Entity Type | Individual
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Provider Name | JUSTIN D HARRIS LVN
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Gender | Male
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Dates
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Enumeration Date | 03/14/2018
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Last Update Date | 03/14/2018
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Provider Practice Location Address
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Address Line | 3605 NE LOOP 286 STE 200
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City | PARIS
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State | TX
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Zip | 75460-5091
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Country | US
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Telephone | 903-737-4337
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Fax |
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Provider Business Mailing Address
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Address Line | 165 COUNTY ROAD 45800
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City | BLOSSOM
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State | TX
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Zip | 75416-2987
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Country | US
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Telephone | 903-249-6906
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 309472
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License Number State | TX
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