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General NPI Number Information
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NPI Number | 1720713522
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Entity Type | Individual
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Provider Name | MARQUITA SHANTA HARRIS PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 704 CROMWELL DR STE A
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City | GREENVILLE
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State | NC
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Zip | 27858-5894
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Country | US
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Telephone | 252-486-6573
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Fax | 855-595-2926
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Provider Business Mailing Address
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Address Line | 2120 E FIRE TOWER RD STE 107-1140
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City | GREENVILLE
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State | NC
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Zip | 27858-9284
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Country | US
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Telephone | 252-486-6573
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Fax | 855-595-2926
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5016504
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License Number State | NC
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