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General NPI Number Information
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NPI Number | 1508287590
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Entity Type | Individual
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Provider Name | BREANNA HARRIS MD
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Gender | Female
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 1714 STATE HIGHWAY 22 W
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City | DARDANELLE
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State | AR
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Zip | 72834-2907
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Country | US
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Telephone | 479-477-3084
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Fax | 479-477-3098
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Provider Business Mailing Address
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Address Line | 1714 STATE HIGHWAY 22 W
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City | DARDANELLE
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State | AR
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Zip | 72834-2907
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Country | US
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Telephone | 479-477-3084
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Fax | 479-477-3098
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | E-17639
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | U1681
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10075205
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License Number State | TX
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